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Purpose To evaluate yoga's impact on inflammation, mood, and fatigue. Patients and Methods A randomized controlled 3-month trial was conducted with two post-treatment assessments of 200 breast cancer survivors assigned to either 12 weeks of 90-minute twice per week hatha yoga classes or a wait-list control. The main outcome measures were lipopolysaccharide-stimulated production of proinflammatory cytokines interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-), and interleukin-1 (IL-1), and scores on the Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF), the vitality scale from the Medical Outcomes Study 36-item Short Form (SF-36), and the Center for Epidemiological Studies-Depression (CES-D) scale. Results Immediately post-treatment, fatigue was not lower (P > .05) but vitality was higher (P = .01) in the yoga group compared with the control group. At 3 months post-treatment, fatigue was lower in the yoga group (P = .002), vitality was higher (P = .01), and IL-6 (P = .027), TNF- (P = .027), and IL-1 (P = .037) were lower for yoga participants compared with the control group. Groups did not differ on depression at either time (P > .2). Planned secondary analyses showed that the frequency of yoga practice had stronger associations with fatigue at both post-treatment visits (P = .019; P < .001), as well as vitality (P = .016; P = .0045), but not depression (P > .05) than simple group assignment; more frequent practice produced larger changes. At 3 months post-treatment, increasing yoga practice also led to a decrease in IL-6 (P = .01) and IL-1 (P = .03) production but not in TNF- production (P > .05). Conclusion Chronic inflammation may fuel declines in physical function leading to frailty and disability. If yoga dampens or limits both fatigue and inflammation, then regular practice could have substantial health benefits.

Juvenile idiopathic arthritis (JIA) is a chronic rheumatic disease associated with pain, stiffness, and psychosocial difficulties. The purpose of this case study was to investigate the impact of a yoga intervention on pain and morning stiffness in an adolescent female with JIA. A secondary aim was to assess the impact of this intervention on self-efficacy, mindfulness, health-related quality of life, and disease activity. A 17-y-old female with JIA participated in 3 yoga groups and home yoga practice with a digital video disc. She engaged in daily self-monitoring of pain and stiffness and completed questionnaires assessing psychosocial functioning and disease activity at pre- and postintervention, and psychosocial functioning at 3-mo follow-up. Primary outcomes were evaluated using quasi-experimental single-case design structure (ie, ABAB), with emphasis on the report of means. Results suggested that yoga reduced pain intensity, stiffness intensity, and duration of morning stiffness. Outcomes for disease activity also suggested improvements. Modest changes were revealed on psychosocial outcome measures, however not consistently in the direction of hypotheses. Anecdotal reports from the participant indicated acceptability of the intervention and improvements in pain and stiffness attributed to engaging in the yoga intervention. More research is warranted to further explore the impact of yoga for youth with JIA as an adjunctive component of multidisciplinary treatment targeting pain, stiffness, disease activity, and psychosocial factors.

<p>A multiple baseline design across three grade level groups with a comparison group was employed to investigate the effectiveness of yoga for improving time on task with 10 elementary school children who evidenced attention problems. A yoga videotape, published by Gaiam, was used that required the children to follow an adult instructor and three children who engaged in deep breathing, physical postures, and relaxation exercises for 30 minutes, twice a week, for a period of 3 weeks. Time on task was defined as the percentage of intervals observed that the students were orientating toward the teacher or task, and performing the requested classroom assignments. The results indicated effect sizes that ranged from 1.5 to 2.7 as a function of the intervention. Effect sizes at follow-up decreased, but ranged from .77 to 1.95. Peer comparison data indicated that classmates’ time on task remained essentially unchanged throughout the three phases of the study.</p>
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Attention-deficit/hyperactivity disorder (ADHD) is a chronic developmental disorder affecting 3-7% of children. In light of the growing utilization of yoga, mindfulness, and meditation in ADHD populations and potential benefits it has on ADHD symptoms, executive function deficits, and social functioning, we sought to evaluate these interventions for youth with ADHD. The primary aim of this review paper is to identify the efficacy of these programs for the treatment of youth with ADHD through a systematic review and meta-analysis. A systematic literature search was conducted in the following electronic databases: PsychINFO, ERIC, PubMed, and MEDLINE. Studies were included in the meta-analytic review if participants were between 5-17 years old, had a diagnosis of ADHD or met symptom threshold on psychometrically-validated measure of ADHD symptoms, was a treatment outcome study, and was published in a peer-reviewed English-language journal. The effect sizes of eleven studies demonstrate that yoga, mindfulness-based interventions, and/or meditation had a statistically significant effect on the outcomes of ADHD symptoms, hyperactivity, and inattention (parent and teacher report), as well as parent-child relationship, executive functioning, on-task behavior, parent stress, and parent trait-mindfulness (p < 0.05). The effect sizes range from small to large effects across these outcomes. Considerable risk for bias was found across studies. Given significant methodological limitations of the literature, positive effect sizes found in studies should be interpreted with caution; these interventions should not be considered first-line interventions for ADHD. However, preliminary findings suggest yoga, mindfulness, and meditation may be beneficial for youth with ADHD, but extensive research is required to validate the efficacy of these interventions.

OBJECTIVE: The purpose of this pilot study was to investigate the palliative potential of home-based yoga sessions provided to women with advanced cancer. METHOD: Personalised 45-minute yoga sessions were offered to three women with advanced cancer by an experienced yoga teacher. Each woman took part in a one-to-one interview after the completion of the yoga programme and was asked to describe her experiences of the programme's impact. RESULTS: The personalised nature of the yoga sessions resulted in similar positive physical and psychosocial effects comparable to those demonstrated in other studies with cancer patients. Participants described physical, mental, and emotional benefits as well as the alleviation of illness impacts. The enhancement of mind-body and body-spirit connections were also noted. CONCLUSION: Personalised home-based yoga programmes for people with advanced cancer may produce similar benefits, including palliation, as those institutionally-based programmes for people with non-advanced cancer.

OBJECTIVE: To examine the acute maternal and fetal effects of yoga postures and suspected contraindicated postures in a prospective cohort of healthy pregnant women in the third trimester. METHODS: This was a prospective study that evaluated pregnant women between 35 0/7 and 37 6/7 weeks of gestation in a one-on-one yoga session. A baseline nonstress test, vital signs, and pulse oximetry were performed. Participants then assumed 26 yoga postures. Vital signs, pulse oximetry, tocometry, and continuous fetal heart rate monitoring were obtained in each posture. Postsession nonstress test, vital signs, and pulse oximetry were obtained. Participants were contacted 24 hours postsession. RESULTS: Twenty-five healthy pregnant women were evaluated. Ten reported regular yoga practice, eight were familiar with yoga, and seven had no yoga experience. Yoga groups were similar in age, race, body mass index, gestational age, and parity. Presession and postsession nonstress tests were reactive. Presession and postsession data showed no change in maternal heart rate, temperature, pulse oximetry, or fetal heart rate. During the 26 yoga postures, vital signs, pulse oximetry, and uterine tocometry remained normal in all women and in all postures. The fetal heart rate across all 26 postures was normal. There were no falls or injuries during the total cumulative 650 poses. No participants reported decreased fetal movement, contractions, leakage of fluid, or vaginal bleeding in the 24-hour follow-up. CONCLUSION: All 26 yoga postures were well-tolerated with no acute adverse maternal physiologic or fetal heart rate changes. LEVEL OF EVIDENCE: III.

INTRODUCTION: Vaqas and Ryan (2003) advocated yoga and breathing exercises for lymphedema. Narahari et al. (2007) developed an integrative medicine protocol for lower-limb lymphedema using yoga. Studies have hypothesized that yoga plays a similar role as that of central manual lymph drainage of Foldi's technique. This study explains how we have used yoga and breathing as a self-care intervention for breast cancer-related lymphedema (BCRL). METHODS: The study outcome was to create a yoga protocol for BCRL. Selection of yoga was based on the actions of muscles on joints, anatomical areas associated with different groups of lymph nodes, stretching of skin, and method of breathing in each yoga. The protocol was piloted in eight BCRL patients, observed its difficulties by interacting with patients. A literature search was conducted in PubMed and Cochrane library to identify the yoga protocols for BCRL. RESULTS: Twenty yoga and 5 breathing exercises were adopted. They have slow, methodical joint movements which helped patients to tolerate pain. Breathing was long and diaphragmatic. Flexion of joints was coordinated with exhalation and extension with inhalation. Alternate yoga was introduced to facilitate patients to perform complex movements. Yoga's joint movements, initial positions, and mode of breathing were compared to two other protocols. The volume reduced from 2.4 to 1.2 L in eight patients after continuous practice of yoga and compression at home for 3 months. There was improvement in the range of movement and intensity of pain. DISCUSSION: Yoga exercises were selected on the basis of their role in chest expansion, maximizing range of movements: flexion of large muscles, maximum stretch of skin, and thus part-by-part lymph drainage from center and periphery. This protocol addressed functional, volume, and movement issues of BCRL and was found to be superior to other BCRL yoga protocols. However, this protocol needs to be tested in centers routinely managing BCRL.

UNLABELLED: This study investigated whether a 7-week yoga intervention could improve physical function, perceived stress, and mental/emotional wellness in elderly participants. METHODS: 8 participants (66.5 +/- 0.3 years) attended 2 60-min Hatha yoga sessions/week for 7 weeks, and performed pre- and post-intervention assessments. Balance was assessed using a 5-test battery. Flexibility was measured by sit-and-reach and shoulder flexibility tests. Functional mobility tests included 8-ft up-and-go, 5 chair stands, and 4-m walk. Participants completed SF-12, exhaustion level, and Perceived Stress Scale (PSS) questionnaires. RESULTS: SF-12 Mental Component Summary scores, exhaustion levels, and PSS scores improved post-intervention. No differences were found for physical function measures. CONCLUSIONS: Yoga participation can improve mental/emotional wellness, exhaustion levels, and stress levels in elderly individuals, even without measurable improvements in physical function. Clinicians and health practitioners who work with the elderly should consider yoga as a potential therapeutic modality for improving important aspects of quality of life in this population.

UNLABELLED: This study investigated whether a 7-week yoga intervention could improve physical function, perceived stress, and mental/emotional wellness in elderly participants. METHODS: 8 participants (66.5 +/- 0.3 years) attended 2 60-min Hatha yoga sessions/week for 7 weeks, and performed pre- and post-intervention assessments. Balance was assessed using a 5-test battery. Flexibility was measured by sit-and-reach and shoulder flexibility tests. Functional mobility tests included 8-ft up-and-go, 5 chair stands, and 4-m walk. Participants completed SF-12, exhaustion level, and Perceived Stress Scale (PSS) questionnaires. RESULTS: SF-12 Mental Component Summary scores, exhaustion levels, and PSS scores improved post-intervention. No differences were found for physical function measures. CONCLUSIONS: Yoga participation can improve mental/emotional wellness, exhaustion levels, and stress levels in elderly individuals, even without measurable improvements in physical function. Clinicians and health practitioners who work with the elderly should consider yoga as a potential therapeutic modality for improving important aspects of quality of life in this population.

UNLABELLED: Background Interventions are needed to alleviate memory difficulty in cancer survivors. We previously showed in a phase III randomized clinical trial that YOCAS(c)(R) yoga-a program that consists of breathing exercises, postures, and meditation-significantly improved sleep quality in cancer survivors. This study assessed the effects of YOCAS(c)(R) on memory and identified relationships between memory and sleep. STUDY DESIGN AND METHODS: Survivors were randomized to standard care (SC) or SC with YOCAS(c)(R) . 328 participants who provided data on the memory difficulty item of the MD Anderson Symptom Inventory are included. Sleep quality was measured using the Pittsburgh Sleep Quality Index. General linear modeling (GLM) determined the group effect of YOCAS(c)(R) on memory difficulty compared with SC. GLM also determined moderation of baseline memory difficulty on postintervention sleep and vice versa. Path modeling assessed the mediating effects of changes in memory difficulty on YOCAS(c)(R) changes in sleep and vice versa. RESULTS: YOCAS(c)(R) significantly reduced memory difficulty at postintervention compared with SC (mean change: yoga=-0.60; SC=-0.16; P<.05). Baseline memory difficulty did not moderate the effects of postintervention sleep quality in YOCAS(c)(R) compared with SC. Baseline sleep quality did moderate the effects of postintervention memory difficulty in YOCAS(c)(R) compared with SC (P<.05). Changes in sleep quality was a significant mediator of reduced memory difficulty in YOCAS(c)(R) compared with SC (P<.05); however, changes in memory difficulty did not significantly mediate improved sleep quality in YOCAS(c)(R) compared with SC. CONCLUSIONS: In this large nationwide trial, YOCAS(c)(R) yoga significantly reduced patient-reported memory difficulty in cancer survivors.

OBJECTIVES: To measure trauma-related distress and evaluate the feasibility, acceptability, and preliminary efficacy of an 8-week yoga intervention (YI) in reducing trauma-related symptoms and emotional and behavioral difficulties (EBD) among children living in orphanages in Haiti.DESIGN: Case comparison with random assignment to YI or aerobic dance control (DC) plus a nonrandomized wait-list control (WLC) group. SETTING: Two orphanages for children in Haiti. PARTICIPANTS: 76 children age 7 to 17 years. INTERVENTION: The YI included yoga postures, breathing exercises, and meditation. The DC group learned a series of dance routines. The WLC group received services as usual in the institutional setting. After completion of data collection, the WLC group received both yoga and dance classes for 8 weeks. OUTCOME MEASURES: The UCLA PTSD Reaction Index and the Strengths and Difficulties Questionnaire were used to indicate trauma-related symptoms and EBD, respectively. A within-subject analysis was conducted to compare pre- and post-treatment scores. A post-treatment yoga experience questionnaire evaluated acceptability of the YI. RESULTS: Analyses of variance revealed a significant effect (F[2,28]=3.30; p=0.05) of the YI on the trauma-related symptom scores. Regression analyses showed that participation in either 8 weeks of yoga or dance classes suggested a reduction in trauma-related symptoms and EBD, although this finding was not statistically significant (p>0.05). Respondents reported satisfaction with the yoga program and improved well-being. CONCLUSIONS: Children with trauma-related distress showed improvements in symptoms after participation in an 8-week yoga program compared to controls. Yoga is a feasible and acceptable activity with self-reported benefits to child mental and physical health. Additional research is needed to further evaluate the effect of yoga to relieve trauma-related distress and promote well-being among children.

OBJECTIVES: To measure trauma-related distress and evaluate the feasibility, acceptability, and preliminary efficacy of an 8-week yoga intervention (YI) in reducing trauma-related symptoms and emotional and behavioral difficulties (EBD) among children living in orphanages in Haiti.DESIGN: Case comparison with random assignment to YI or aerobic dance control (DC) plus a nonrandomized wait-list control (WLC) group. SETTING: Two orphanages for children in Haiti. PARTICIPANTS: 76 children age 7 to 17 years. INTERVENTION: The YI included yoga postures, breathing exercises, and meditation. The DC group learned a series of dance routines. The WLC group received services as usual in the institutional setting. After completion of data collection, the WLC group received both yoga and dance classes for 8 weeks. OUTCOME MEASURES: The UCLA PTSD Reaction Index and the Strengths and Difficulties Questionnaire were used to indicate trauma-related symptoms and EBD, respectively. A within-subject analysis was conducted to compare pre- and post-treatment scores. A post-treatment yoga experience questionnaire evaluated acceptability of the YI. RESULTS: Analyses of variance revealed a significant effect (F[2,28]=3.30; p=0.05) of the YI on the trauma-related symptom scores. Regression analyses showed that participation in either 8 weeks of yoga or dance classes suggested a reduction in trauma-related symptoms and EBD, although this finding was not statistically significant (p>0.05). Respondents reported satisfaction with the yoga program and improved well-being. CONCLUSIONS: Children with trauma-related distress showed improvements in symptoms after participation in an 8-week yoga program compared to controls. Yoga is a feasible and acceptable activity with self-reported benefits to child mental and physical health. Additional research is needed to further evaluate the effect of yoga to relieve trauma-related distress and promote well-being among children.

OBJECTIVE: The objective of this research was to examine the evidence for delivering yoga-based interventions in schools.METHODS: An electronic literature search was conducted to identify peer-reviewed, published studies in which yoga and a meditative component (breathing practices or meditation) were taught to youths in a school setting. Pilot studies, single cohort, quasi-experimental, and randomized clinical trials were considered. RESEARCH: quality was evaluated and summarized. RESULTS: Twelve published studies were identified. Samples for which yoga was implemented as an intervention included youths with autism, intellectual disability, learning disability, and emotional disturbance, as well as typically developing youths. CONCLUSION: Although effects of participating in school-based yoga programs appeared to be beneficial for the most part, methodological limitations, including lack of randomization, small samples, limited detail regarding the intervention, and statistical ambiguities curtailed the ability to provide definitive conclusions or recommendations. Findings speak to the need for greater methodological rigor and an increased understanding of the mechanisms of success for school-based yoga interventions.

A yoga-based school-wide positive behavior support (SWPBS) may provide a foundation for teaching mindfulness and self-regulation in K-12 schools. Here, the use of yoga as a SWPBS was examined through a review of existing literature and interviews of yoga program facilitators. Yoga was reported to be effective as a pedagogical approach, and found to increase mindfulness, emotional regulation, and positive behaviors of school students. Findings suggest yoga, when provided by culturally sensitive instructors, may be an easy to implement, cost-effective SWPBS in a variety of school settings.

OBJECTIVE: To evaluate the effect of Integral-based hatha yoga in sedentary people with arthritis. METHODS: There were 75 sedentary adults aged 18+ years with rheumatoid arthritis (RA) or knee osteoarthritis randomly assigned to 8 weeks of yoga (two 60-min classes and 1 home practice/wk) or waitlist. Poses were modified for individual needs. The primary endpoint was physical health [Medical Outcomes Study Short Form-36 (SF-36) physical component summary (PCS)] adjusted for baseline; exploratory adjusted outcomes included fitness, mood, stress, self-efficacy, SF-36 health-related quality of life (HRQOL), and RA disease activity. In everyone completing yoga, we explored longterm effects at 9 months. RESULTS: Participants were mostly female (96%), white (55%), and college-educated (51%), with a mean (SD) age of 52 years (12 yrs). Average disease duration was 9 years and 49% had RA. At 8 weeks, yoga was associated with significantly higher PCS (6.5, 95% CI 2.0-10.7), walking capacity (125 m, 95% CI 15-235), positive affect (5.2, 95% CI 1.4-8.9), and lower Center for Epidemiologic Studies Depression Scale (-3.0, 95% CI -4.8 - -1.3). Significant improvements (p < 0.05) were evident in SF-36 role physical, pain, general health, vitality, and mental health scales. Balance, grip strength, and flexibility were similar between groups. Twenty-two out of 28 in the waitlist group completed yoga. Among all yoga participants, significant (p < 0.05) improvements were observed in mean PCS, flexibility, 6-min walk, and all psychological and most HRQOL domains at 8 weeks with most still evident 9 months later. Of 7 adverse events, none were associated with yoga. CONCLUSION: Preliminary evidence suggests yoga may help sedentary individuals with arthritis safely increase physical activity, and improve physical and psychological health and HRQOL. Clinical Trials NCT00349869.

Yoga therapy is a newly emerging, self-regulating complementary and integrative healthcare (CIH) practice. It is growing in its professionalization, recognition and utilization with a demonstrated commitment to setting practice standards, educational and accreditation standards, and promoting research to support its efficacy for various populations and conditions. However, heterogeneity of practice, poor reporting standards, and lack of a broadly accepted understanding of the neurophysiological mechanisms involved in yoga therapy limits the structuring of testable hypotheses and clinical applications. Current proposed frameworks of yoga-based practices focus on the integration of bottom-up neurophysiological and top-down neurocognitive mechanisms. In addition, it has been proposed that phenomenology and first person ethical inquiry can provide a lens through which yoga therapy is viewed as a process that contributes towards eudaimonic well-being in the experience of pain, illness or disability. In this article we build on these frameworks, and propose a model of yoga therapy that converges with Polyvagal Theory (PVT). PVT links the evolution of the autonomic nervous system to the emergence of prosocial behaviors and posits that the neural platforms supporting social behavior are involved in maintaining health, growth and restoration. This explanatory model which connects neurophysiological patterns of autonomic regulation and expression of emotional and social behavior, is increasingly utilized as a framework for understanding human behavior, stress and illness. Specifically, we describe how PVT can be conceptualized as a neurophysiological counterpart to the yogic concept of the gunas, or qualities of nature. Similar to the neural platforms described in PVT, the gunas provide the foundation from which behavioral, emotional and physical attributes emerge. We describe how these two different yet analogous frameworks-one based in neurophysiology and the other in an ancient wisdom tradition-highlight yoga therapy's promotion of physical, mental and social wellbeing for self-regulation and resilience. This parallel between the neural platforms of PVT and the gunas of yoga is instrumental in creating a translational framework for yoga therapy to align with its philosophical foundations. Consequently, yoga therapy can operate as a distinct practice rather than fitting into an outside model for its utilization in research and clinical contexts.

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