This action might not be possible to undo. Are you sure you want to continue?
• A Yoga Intervention for Young Adults With Elevated Symptoms of Depression Alison Woolery, MA; Hector Myers, PhD; Beth Sternlieb, BFA; Lonnie Zeltzer, MD • Feasibility of Conducting A Clinical Trial on Hatha Yoga for Chronic Low Back Pain: Methodological Lessons Bradly P. Jacobs MD, MPH; Wolf Mehling, MD; Harley Goldberg, DO; Elissa Eppel, PhD; Michael Acree, PhD; Judith Lasater, PT, PhD; Christine Miasowski, PhD • Hatha Yoga and Meditation in Patients With Post-Polio Syndrome William DeMayo, MD; Betsy Singh, PhD; Barbara Duryea; David Riley, MD • Hatha Yoga and the Treatment of Illness David Riley, MD • Prevalence and Patterns of Adult Yoga Use in the United States: Results of a National Survey Robert B. Saper, MD, MPH; David M. Eisenberg, MD; Roger B. Davis, ScD; Larry Culpepper, MD, MPH; Russell S. Phillips, MD • The Impact of Modiﬁed Hatha Yoga on Chronic Low Back Pain: A Pilot Study Mary Lou Galantino, PT, PhD; Todd M. Bzdewka, MPT; Jamie L. Eissler-Russo, MPT; Matthew L. Holbrook , MPT; Eric P. Mogck, MPT; Paula Geigle, PT, PhD; John T. Farrar, MD, MSCE
there was a trend for higher morning cortisol levels in the yoga group by the end of the yoga course. (Altern Ther Health Med. Beth Sternlieb. MAR/APR 2004. Design • Young adults pre-screened for mild levels of depression were randomly assigned to a yoga course or wait-list control group. CO 80301. I 60 ALTERNATIVE THERAPIES. PhD. Los Angeles. Finally. making it difficult to determine whether the mood-enhancing effects of yoga are general or specific to certain approaches or teachers. NO. compared to controls. MA PhD BFA MD Alison Woolery. 2 Yoga Intervention for Young Adults with Depression . Psychiatry and Biobehavioral Sciences. . but scientific research on yoga and depression is limited. Changes also were observed in acute mood. Therefore. Within the Iyengar yoga tradition. with subjects reporting decreased levels of negative mood and fatigue following yoga classes. These effects emerged by the middle of the yoga course and were maintained by the end. Additionally. these studies used different forms of yoga (eg.) t is not unusual for yoga teachers and students to report that yoga has an uplifting effect on their moods. No predictions were made in this regard. is a graduate student at the Department of Psychology. no prospective studies have tested how the practice of physical postures (asanas). 10. a small body of research suggests that yogic techniques may help alleviate symptoms of depression.4-7 However. Los Angeles. . as opposed to breathing and meditation. MA. Los Angeles. 2004. phone. since depression has been associated with abnormal levels of cortisol. even when they are dysphoric. Finally. is professor of psychology. specific asanas and sequences of asanas are thought to be particularly effective for alleviating depression. e-mail. the need for future studies with larger samples and more complex study designs to more fully evaluate the effects of yoga on mood disturbances. Congruent with these reports. breathing. MD. Setting • College campus recreation center. Main Outcome Measures • Beck Depression Inventory. and inversions. UCLA Pediatric Pain Program. is a Certified Iyengar Yoga Instructor and Yoga Instructor. physical postures). Hector Myers. Objective • To examine the effects of a short-term Iyengar yoga course on mood in mildly depressed young adults. Boulder. To our knowledge. These findings provide suggestive evidence of the utility of yoga asanas in improving mood and support Reprint requests: InnoVision Health Media. morning cortisol levels. In addition.S.10(2):60-63. 1-3 Other studies on non-depressed persons have found increased positive and decreased negative mood following yoga practices.brief report A YOGA INTERVENTION FOR YOUNG ADULTS WITH ELEVATED SYMPTOMS OF DEPRESSION Alison Woolery. (303) 440-7402. 8 These include asanas that open and lift the chest. as well as immediate reductions in acute negative mood and fatigue following each yoga class. compared to those who were randomly assigned to a wait-list control group. Iyengar. standing poses. None had significant yoga experience. is Director. we explored changes in morning cortisol levels. and vigorous standing poses. particularly back bends. (303) 440-7446. Intervention • Subjects in the yoga group attended two 1–hour Iyengar yoga classes each week for 5 consecutive weeks. StateTrait Anxiety Inventory. Lonnie Zeltzer. alternative-therapies@innerdoorway. since symptoms of depression and anxiety are often associated. based on the teachings of yoga master B. The classes emphasized yoga postures thought to alleviate depression. we expected that those who took the yoga course would evidence reductions in trait anxiety. 2995 Wilderness Place. but had received no current psychiatric diagnoses or treatments. Anesthesiology. VOL. University of California. BFA. Professor of Pediatrics. The purpose of this pilot study was to examine the effects of a five-week Iyengar yoga course on symptoms of depression in mildly depressed young adults. impacts mood in persons who are depressed. Beth Sternlieb. all participants were experiencing mild levels of depression. UCLA Pediatric Pain Program. Suite 205. we expected that mildly depressed adults who participated in an Iyengar yoga course for depression would show a reduction in self-reported symptoms of depression by the end of the course. Participants • Twenty-eight volunteers ages 18 to 29. meditation. the validity and clinical utility of these findings have been questioned because of a number of methodological limitations. Profile of Mood States. David Geffen School of Medicine at the University of California.com. Hector Myers. At intake.K. Lonnie Zeltzer. especially back bends. fax. inversions. University of California. Context • Yoga teachers and students often report that yoga has an uplifting effect on their moods. Results • Subjects who participated in the yoga course demonstrated significant decreases in self-reported symptoms of depression and trait anxiety. .
or expected benefits from learning yoga. P = .53) 4. Control Group Subjects in the control group were asked to maintain their routine activities and not begin any yoga or other mind-body program during the course of the study. Subjects were instructed to provide saliva samples immediately upon awakening on 3 different mornings (pre-test. 3 subjects dropped out of the yoga group and two dropped out of the control group. and last classes. had no medical contraindications to exercise.01 (see Figure 1). motivation to attend yoga classes.and post-test.9 the Spielberger Trait Anxiety Inventory10 (STAI). mid-course. They were randomly assigned to the yoga group (N = 13) or to a wait-list control group (N = 15). A similar pattern emerged for trait anxiety. Subjects returned samples on the same days that they collected them.13. fifth. anxiety. Yoga Intervention for Young Adults with Depression ALTERNATIVE THERAPIES. and enroll the 28 eligible subjects. As expected.04. and post-test that were time-matched to weeks during which subjects in the yoga group provided equivalent data. the results indicated that the yoga group showed a significantly greater reduction in depression compared to the control group.21) = 28.5. motivation. (Most systems of yoga discourage menstruating women from practicing inversions.001) but not for control subjects (t(12) = . The classes emphasized postures that. as indicated by a score of 10-15 on the Beck Depression Inventory (BDI). A variety of recruitment strategies were used to screen. and a Pearson correlation was conducted.85 (7. PA).73 (8.58 (5.35 . and the samples were immediately stored in a freezer.23) 11.20) = 9. Subjects were taught the Iyengar approach to yoga by a certified Iyengar yoga teacher. according to the Iyengar yoga perspective. by Group Group Yoga YTime Pretest Midcourse Posttest Pretest Midcourse Posttest Depression1 12. and inversions. At intake.15) NA 45. 28 volunteers ages 18 to 29 (mean age = 21.44) Cortisol (ug/dL) . P < .9 but had no current psychiatric diagnosis. NO. with the yoga group participants reporting decreased anxiety compared to controls. sd = 3.32 Yoga Class Subjects in the yoga group attended two 1 hour yoga classes each week for 5 consecutive weeks. and had no current problems with alcohol or substance abuse.45 .90 (4. particularly back bends.60 (6. midcourse. Cortisol samples were collected via plastic salivettes. P < . VOL. including the BDI. 2 61 .32) Anxiety2 49.50 (3. Controls attended three data collection meetings at pre-test.61.30. 3 Anxiety only was measured at pretest and posttest. The majority of subjects were females (79%) and students (82%). All subjects were taught the same asanas. State College. Brief surveys also were administered at pre-test to assess interest. Wait-List 1 2 Beck Depression Inventory Score.78) 3. F(1.001 (see Figure 2).001). were non-smokers. Post-hoc comparisons indicate that these differences emerged midway through the course (t(21) = -3.23) were recruited.67 (5. P < . were not suicidal. P < . P = . motivation. TABLE 1 Means and Standard Deviations of Depression. and at end of the yoga course. Classes were held in the morning at a campus recreation center. Following these initial analyses. interest in learning yoga. and expected benefits from taking yoga. To determine if change in depression was related to change in anxiety among yoga participants. which was administered to assess current mood before and after the first.METHODS Subjects To test these hypotheses.20) 45. midway through the yoga course.44 .78.43 .) Subjects were not encouraged to practice at home.45). RESULTS Independent t-tests comparing the yoga and control groups at baseline indicated no group differences in depression. 10. the one exception being that menstruating women practiced alternatives to inversions. select. F(2.78. and that these mood changes were unrelated to subjects’ initial interest. P < . They were not already practicing yoga or other forms of complementary/alternative medicine. Paired t-tests conducted within each group showed that depression scores at baseline differed from depression scores after the last yoga class for subjects in the yoga group (t(9) = 5. All subjects (yoga and control) received $30 gift certificates for participating in the study. Cortisol was measured using a high sensitivity salivary cortisol immunoassay kit (Salimetrics.07 (4. all subjects were experiencing mild levels of depression. Spielberger Trait Anxiety Score. change scores were computed for depression and anxiety. Anxiety.41) 10. nor were currently receiving any treatment for any psychiatric condition. During the course of the study. Classes ended with relaxation postures that open the chest.77 (4.01) and were maintained at the end of the yoga course (t(21) = -3. Results indicated that change in depression was not significantly related to change in anxiety (r = . are supposed to alleviate depression. standing poses.00 (4. a 2 X 3 repeated measures ANOVA using GLM was conducted to test for group differences on depression at baseline.41).63) NA3 39. and Cortisol. and post-test).37 . and expectation of benefit surrounding yoga. and the Profile of Mood States11 (POMS). The research was conducted after obtaining approval from the Human Subjects Protection Committee and was carried out consistent with the ethical guidelines of the American Psychological Association.66) 12. Measures A short battery of self-report measures was administered at pre.31. MAR/APR 2004.
midcourse. The results confirmed expectations of the potential benefits of using yoga asanas that open and lift the chest. so that subjects whose scores dropped below the inclusion cutoff could be dropped before treatment. For example. as well as standing poses and inversions to improve mood. The small sample size also limits power to adequately test changes in cortisol. case-control study examined how participating in a 5-week. the use of a wait-list control condition. NO. should be treated with caution because of several methodological limitations. Future studies should also investigate whether the moodmoderating effects of yoga are comparable to those observed for aerobic exercise. The study would have been strengthened by the inclusion of a baseline washout period. larger samples. while encouraging. as opposed to a placebo or alternative treatment control condition. Finally. Discussion This randomized. A longer intervention period might have augmented the positive effects of the yoga. and lower levels of nervousness.14 12 BDI Score 10 8 6 4 2 pre-test midcourse Time FIGURE 1 Change in depression scores by group (yoga versus control) across pre-test. a broader array of biological measures. particularly backbends. and the mood measures are limited by the social desirability inherent in all self-report measures. both are activating.to post-class reductions in depression-dejection. independent sample t-tests were conducted to test for group differences in morning cortisol level. MAR/APR 2004. t(17) = 1. Although elevated cortisol responses to stress are associated with pathophysiological consequences. may have experienced enhanced feelings of mastery. and tenacity. depression.16 Although yoga and exercise are not synonymous. STAI = State Trait Anxiety Inventory post-test GROUP yoga group control group Next. hardiness. Various aspects of the class could account for the observed effects of yoga on mood. but a trend emerged at the end of the yoga course indicating that participants in the yoga group evidenced higher morning cortisol levels than the controls. These findings on self-reported mood are supported by suggestive evidence of slightly higher morning cortisol levels in those who participated in the yoga classes compared to controls by the end of the course.12-13 Finally. In conclusion. VOL. Future studies should address these limitations by employing alternative control conditions. this randomized pilot study indicates that participating in a short-term Iyengar yoga course may have therapeutic benefits for people experiencing mild levels of 62 ALTERNATIVE THERAPIES. No differences were observed at baseline or midcourse. limits our ability to distinguish the effects of yoga training from the possible effects of attention and expectation. Participants were challenged to learn fairly difficult asanas and. Significant reductions in confusion-bewilderment and total mood disturbance were observed at the last class. a connection between open body posture and mood has been supported by several psychological studies. tension-anxiety. anger-hostility.08. consequently. comparison trials could explore whether yoga has effects on depression beyond the effects of general activation. as well as test for differences in the speed and magnitude of response to yoga versus exercise. From the yogic perspective. and post-test. and emotional lability. BDI = Beck Depression Inventory post-test GROUP yoga group control group 14 12 BDI Score 10 8 6 4 2 pre-test midcourse Time FIGURE 2 Change in anxiety scores by group (yoga versus control) from pre-test to post-test. which has been shown to be an effective treatment for depression. and total mood disturbance at the first and fifth classes. 2 Yoga Intervention for Young Adults with Depression . Interestingly. the backbends and other chestopening poses emphasized in these classes may have countered the slumped body posture associated with depression. fatigue-inertia. These effects were most evident by the middle of the yoga course and continued through the end of the course.83. exploratory paired t-tests were run to assess the impact of the yoga classes on acute mood. more diverse outcomes (particularly clinician-based ratings of depression). 10-session Iyengar yoga course affected mood in individuals with mild levels of depression. higher morning cortisol levels have been associated with self-esteem. P = . confusion-bewilderment. and participants with more moderate levels of depression. The yoga classes were activating in that they were vigorous and occurred relatively early in the morning.14-15 These results. Therefore. the classes may have provided stress relief by combing intense focus on joint and muscle movements during the classes with relaxation at the end of each class. The results indicated significant pre. 10. Future research should further explore these and other potential mechanisms.
N. J Psychosom Res. Lushene. Stern. Government Printing Office. Indian Journal of Clinical Psychology.C.W.47:479-493. Future research should seek to replicate and extend these findings while addressing the limitations of this pilot study. Sexter.edu. McNair.. BN. M. DeRubeis. M. improved acute mood. High self-esteem. BKS.44:202-206. N. Patil. N. C. N. 1992. 7.1972. VOL. GB. Emotion-specific effects of facial expressions and postures on emotional experience.322:763-767. Journal of the Royal Society of Medicine. RE. Damodaran. Palo Alto: Consulting Psychologists Press. JD. Murthy. DM. 15. Shah. M. & Van Lighten. Kirschbaum. L. The effectiveness of exercise as an intervention in the management of depression: Systematic review and meta-regression analysis of randomized controlled trials.O. S.42:740-743. et al. Mood alteration with yoga and swimming: aerobic exercise may not be necessary.75:1331-1343. 4. Iyengar. Correspondence concerning this article should be addressed to Alison Woolery. Journal of Personality and Social Psychology. 1989. 6. 2001. In T. Laird. Journal of Affective Disorders. A. Effect of yogic practices on subjective well being. SS.86:254-8.20:591-601. and Manouso Manos. and yoga. & Subbakrishna. 11. SE. Berger. 2. 10. C. 2000. 2 63 . JH. & Owen.20:82-87. A. E. CA. & Maratha. & Subbakrishna. Gangadhar. Measuring depression: The depression inventory. Malathi. Lawlor. MM Katz. Washington. Psychoneuroendocrinology.. DK Normalization of P300 amplitude following treatment in dysthymia. & JA Shields (Eds). 1992. NV. US. 2001. visualization. & Hellhammer. Perceptual and Motor Skills. Schneider. Journal of Personality and Social Psychology. D. M01 RR00080. O. Yoga Intervention for Young Adults with Depression ALTERNATIVE THERAPIES. P. NO. Los Angeles. Profile of Mood States Manual. Iyengar. We wish to express our deep appreciation to B.S. E. BMJ. Jr. 9. They stoop to conquer: Guiding and self-regulatory functions of physical posture after success and failure. DK P300 amplitude and antidepressant response to Sudarshan Kriya Yoga (SKY). D. LF. 1995. DR. 2001. Biological Psychiatry. Janakiramaiah. 12. Developmental and personality correlates of adrenocortical activity as indexed by salivary cortisol: Observations in the gae range of 35 to 65 years.50:42-48. 8. 1970. Email: awoolery@ucla. Beck AT. 10.A. Mood change and perceptions of vitality: a comparison of the effects of relaxation. RJ. Duclos. 1984. Williams. Ray.K. London: Dorling Kindersley.45:37-53. MAR/APR 2004. Effect of yogic exercises on physical and mental health of young fellowship course trainees. upon whose teachings this study is based. Khumar. & Hopker. Riskind.: U. Lorr. S. EP. D. and possible modulation of cortisol.A. 1998. 5. 3. Baltes.35:173-185. Acknowledgments Preparation of this article was supported in part by a National Science Foundation Graduate Fellowship and a grant from the NIH. for his generous advice on the yoga aspects of the study. S Effectiveness of shavasana on depression among university students. P. 1993. hardiness and affective stability are associated with higher basal pituitary-adrenal hormone levels. & Droppleman. San Diego: Education and Industrial Testing Service. Manual for the Stait-Trait Anxiety Inventory. Zorilla. Indian Journal of Physiology and Pharmacology. Indian Journal of Physiology and Pharmacology. 14. Gorsuch. 13. These benefits include reductions in depression and anxiety.A. Yoga: The path to holistic health. BN. CD. 1997. Branstadter. Murthy. 1993. Box 951563. RL. Wood. J. Janakiramaiah. 1285 Franz Hall. General Clinical Research Center. Recent advances in the psychobiology of depressive illnesses (pp 299-302). Spielberger. & Kaur. References 1.depression. Gangadhar.57:100-108. & Redei. BG.. NV. Kaur.S. 16. 1992. 90095-1563.
alternative-therapies@innerdoorway. breathing. .9 However. MPH. and Iyengar yoga makes frequent use of props which are particularly well-suited for people with pain and disability. 4. and over 40% of these practitioners study Iyengar style of Hatha yoga. PhD Bradly P. It is believed that yoga improves strength. Synchrony Applied Health Sciences. DO PhD. relaxation exercises. open-label. yoga may also reduce stress and improve mood and overall well-being.5-7 In particular. Avins MD. Christine Miasowski. We chose to evaluate the safety and effect of the Iyengar style of Hatha yoga for chronic low back pain for 3 primary reasons—it is the most commonly practiced style of Hatha yoga in the US. Andrew L. MD. (303) 440-7446. Wolf Mehling. is a clinical associate professor at pies that has not been extensively evaluated in rigorous clinical research. and other non-conventional therapies. Michael Acree.10. such as chiropractic. wait-list controlled. e-mail. PhD. MD. CO 80301.000 year-old practice that combines the use of body positions (known as “postures”). Jacobs . 11 In addition. there are 15 million US-practitioners (practicing yoga >3 times weekly). tai chi. METHODS Choice of Yoga-Style There are several styles of Hatha yoga commonly practiced in the US. CA. 2995 Wilderness Place. is associate director of research at the Division of Research of Northern California Kaiser Permanente and associate professor in the Department of Medicine. is director of complementary and alternative medicine and director of spine care program for The Permanente Medical Group and assistant clinical professor of family and community medicine. VOL. meditation. is affiliated with the BKS Iyengar Yoga Institute of Northern California. range of motion. Harley Goldberg. we conducted a pilot. ack pain affects 80% of the population1 and total expenses associated with the treatment of back pain in the United States approach $26 billion annually. NM. In order to standardize the intervention for a clinical trial. there are few published studies on the effects of yoga on chronic low back pain. Harley A. clinical trial. is affiliated with the Osher Center for Integrative Medicine. University of California San Francisco (UCSF). MPH. Suite 205. PhD. We are presenting some of our baseline data in the context of discussing the unique challenges and particular issues that must be addressed with any rigorous research of the medical applications of Hatha yoga practice. individual psychological counseling. and Director of the Biostatistics Core at the Osher Center for Integrative Medicine. Cole. UCSF. yoga. According to the Yoga Research and Education Council Report on Yoga statistics. in 2003. acupuncture. fax. Michael Acree. 3) To assess the effect size of a yoga practice intervention for sample size calculations for a full-scale trial. including cognitive-behavioral therapy. The specific aims of the pilot study were: 1) To assess the feasibility of designing and implementing a yoga practice intervention for a clinical trial. Roger J. patient education on proper posture and physical therapy. PhD. we chose one style of Hatha yoga from a major school practiced in the US. yoga classes for people with back pain are routinely available in yoga and fitness studios in the general community.) To evaluate evidence for statistical trends (P<0. Elissa Eppel. phone. Boulder. 2) To assess the feasibility of recruitment and adherence to a yoga practice intervention.2 Therapeutic options within conventional medical practice are limited to analgesics. randomized.Goldberg. B 80 ALTERNATIVE THERAPIES. Del Mar. implantable pain pumps and spinal cord stimulator devices. MD. MPH MD. Judith Lasater PT. is assistant clinical professor and Wolf Mehling.8. and mobilizes the spine and hip joints to reduce pain. is research specialist in the Department of Medicine. DO. PhD. David Riley. MD. is senior research fellow at the Osher Center for Integrative Medicine and Department of Family and Community Medicine. Judith Hanson Lasater.com. PT. UCSF. Pilates. and mental focus to achieve better health. and Feldenkrais method. MA. UCSF. Albuquerque. balance and agility.Hypothesis FEASIBILITY OF CONDUCTING A CLINICAL TRIAL ON HATHA YOGA FOR CHRONIC LOW BACK PAIN: METHODOLOGICAL LESSONS Bradly P. epidural steroid injections. 10. The the University of New Mexico Medical School. It is one of the more promising theraReprint requests: InnoVision Health Media.3 Patients with significant long-term disability and those requiring opiate analgesia may be referred to multi-disciplinary pain treatment centers4 that provide an array of therapeutic options. 2 Hatha Yoga for Chronic Lower Back Pain . it has a national credentialing organization. group support. MAR/APR 2004. (303) 440-7402. Stephanie Maurer. NO. Twelve weeks of semi-weekly Iyengar yoga practice was compared with an educational booklet on treating low back pain given to the wait-list control group.7 To evaluate the effect of yoga on chronic low back pain. UCSF. massage. two-arm. PhD.2) of effectiveness of yoga practice compared with a minimal educational intervention for global assessment. function and average pain intensity. Hatha yoga is a 5. Jacobs.
the panel agreed to limit the yoga intervention to a pre-defined set of postures from which the yoga teacher may select individual poses in varying sequences for each of the 23 yoga classes. The initial poses were standing asanas. DK Publishing. Iyengar BKS. including mandatory poses to be practiced daily (Table 1). Yoga Protocol Development We convened a panel of experts to develop the yoga protocol. VOL. Each instructor was required to meet University of California. 1995.4 variations (knee support.9(5):54-60. leg moved laterally/corner) Jathara Parivartasana with knees bent (side to side) Urdhva Prasarita Padasana with legs up wall Viparita Karani +/. The panel agreed that participating in 90-minute semi-weekly yoga classes over 12 weeks and practicing yoga at home 5 days weekly for 30minutes was sufficient to provide clinical benefit to people with chronic low back pain. Iyengar who has been teaching for more than 60 years (Iyengar BKS. The protocol was constructed by consensus after 2 meetings and several months of discussion. to have a minimum of 10 years experience teaching yoga. Instructors provided participants with an illustrated pamphlet explaining the poses to encourage and support a home-based yoga practice. then lying asanas. a modern emphasis added to the historic practice of Hatha yoga. and experience working with patients with chronic back pain. or arm extended overhead Savasana. This semi-structured approach has been used for clinical trials in evaluating the effect of other traditional healing systems (Sherman KJ. Developing methods for acupuncture research: rationale for and design of a pilot study evaluating the efficacy of acupuncture for chronic low back pain. Twenty-eight asanas (postures) were selected. Iyengar BKS. 10. The panel included 8 senior Iyengar yoga instructors of national and international recognition with greater than 10 years experience teaching yoga. The comparison between the two groups is made during the initial 3 month period. Crossroad Publishing.. one foot supported on stool) Tadasana (mountain pose) Virabhadrasana II or Utthita Parsvakonasana (Side Angle Pose) Uttansana (supported forward bend) or Half-dog pose at wall or Supta Padangusthanasana I (hamstring stretch with belt) Urdhva Mukha Svanasana (Upward Dog) or Setu Bandha Sarvangasana (Bridge pose) Salabhasana (Locust with 1 leg only or 1 leg and 1 contralateral arm) or Bhujagasana (cobra) Listing of Non-mandatory poses: Chair Tadasana Utthita Trikonasana (Triangle +/. recruitment would be difficult if only one-half of all participants would receive the desired group intervention and the other half a general back pain patient information printout. Light on Yoga. Cherkin DC. San Francisco credentialing criteria. Virabhadrasana I with variations such as chair lunge. Furthermore. 2003. These teachings are followed by instruction to increase flexibility of muscle groups and range of motion of joints. block. there is an initial emphasis on body awareness of the affected area. supine) Hatha Yoga for Chronic Lower Back Pain ALTERNATIVE THERAPIES.head support. in which the participant lies supine on the floor with his or her eyes closed while shifting one’s attention to create a relaxed state of being.K. A wait-list control is a condition in which participants are randomized to immediate intervention or assigned to a wait-list after which time they will receive the intervention. side. All participants received a yoga mat. NO. The goal is to create an intervention that is easily replicable by other scientists. the student is directed to utilize breath and awareness in the practice of each posture and the movement between postures. In this case. General themes of each class included instruction on how to breathe and use the mind to focus one’s attention on the physical body and emotions. 1985.).pelvis lift (supine with leg on wall) Adho Mukha Virasana (Child pose) with variation including bolster or blanket supports. Altern Ther Health Med. and. prone.) The system is based on the classic 8 limbs of Patanjali’s Ashtanga Yoga teachings and is well-known for its particular emphasis on postural alignment and movement in the postures.variations. a wait-list control delayed Yoga intervention was chosen as the control arm for the study. Each class concluded with the corpse pose. Throughout this process. and. followed by seated asanas. The Path to Holistic Health. 2001. MAR/APR 2004. Finding an Appropriate Control Intervention As in most clinical trials of non-pharmaceutical complementary and alternative therapies. belly on bolster atop platform. hands on hips Chair Pavanmuktasana (forward bend with chair support -2 chairs) Chair Parsva Pavanmuktasana (Chair forward bend with twist) Baddha Konasana (groin stretch) with support Ardha Pavanmuktasana (supine 1 knee bent) Supta Pavanmuktasana (supine 2 knees to chest) Supta Padangusthasana II (hamstring stretch with belt. belts. Light on Pranayama.Iyengar method is based on the teachings of B. wall (Downward facing dog)/cat . Therefore. at the same time.S. 2 81 . and blankets for their home-based practice. Furthermore. to adhere to the principles of the yoga tradition which emphasizes the need to individualize postures based on the needs of the class.cow Prasarita Padottanasana (Feet spread forward bend) with support such as hand on block or chair. Four Iyengar yoga instructors were selected to teach the participants. In the therapeutic application of the Iyengar method for people with back pain. and finally instruction is given to increase strength and stamina and ensure proper alignment and movement in postures. at wall with block/feet oblique) Parivrtta Trikonasana with support Adho Mukha Svanasana +/. the study intervention with its strong visual and kinesthetic features cannot be blinded for the participant or the provider. TABLE 1 Yoga Intervention Mandatory poses for daily practice: Chair Bharadvajasana (Seated Twist) Utthita Marchyiasana III (standing spinal twist into wall. Schocken Books Inc. and relaxing muscles in spasm or with high resting tension. in addition. the wait-list group received usual care and an back pain educational booklet for 3 months followed by a 3 month yoga intervention.
Table 3). depression. 10. and.30 SF-36 12. ethnicity. inability to participate in twice weekly yoga (n=13). NO. (3) change in functional status (measured by the Roland-Morris Back Disability Questionnaire13 and the Oswestry Scale14). anxiety. Seventy-three of these volunteers (41%) came to the clinic for a screening visit. average pain below 3 out of 10 point maximum score (n=9).0 11.6 14. 2 Hatha Yoga for Chronic Lower Back Pain . MAR/APR 2004.$70. 2003.84 Pain duration 6. Of these attendees.9 P=0.92 Race 16 (70%) 17 (65%) -White 3 (13%) 5 (19%) -Black 1 (4%) 1 (4%) -Hispanic 2 (9%) 3 (12%) -Asian 1 (4%) 0 (0%) -Other P=0. There were no differences between groups with respect to age. Randomization Participants were randomized in equal proportions using a random number generator to yoga and wait-list control groups.37 Educational (median) College graduate College graduate $40. We presented the study to primary care providers and physical therapists at clinic conferences of large inner-city clinics to obtain direct referrals from physicians and physical therapists. a history of back surgery.0 P=0. insomnia. baseline demographic and clinical data were similar between groups.33 Income (median) TABLE 3 Baseline Clinical Characteristics Yoga (N=28) Wait-list (N=24) Statistical Value Characteristic Visual Analog Pain 4.12 (1) participant global assessment of effectiveness. A total of 177 people were screened for the study by phone.4 (25-65) (Table 2). Secondary outcome measurements include biological markers of stress.4 P=0. back-related compensation or litigation.000 . The yoga therapy group had a trend towards more women (P=0. Among the 125 people screened.000 P=0.3 years (Table 3).3 40. general health. Measures The primary quantitative outcome measures include standard measures commonly used in non-specific mechanical low back pain research:11.0 10. to have had pain symptoms for at least 6 and to score a minimum of 3 out of 10 on the Visual Analogue Pain Scale for pain over the past week.24 -maximum 11. 3. Subjects were required to have no plans to move out of the study region within 9 months and to have a life expectancy of more than 9 months. In general. we stratified randomization by age and duration of symptoms and used blocked randomization with a block size of 6.2 43.9 82 ALTERNATIVE THERAPIES.34 Roland-Morris 15. and income (Table 2). the primary reasons for not participating in the trial included lack of interest/no call back to study coordinator (n=37). Stratified randomization succeeded in producing groups similar in age and pain duration: Average age was 43.68 Global Expectation 7. (2) Visual Analogue Pain scores.000 – $55. data collection included measures of potential covariates such as patient expectations. Participants were excluded if their back pain was secondary to malignancy. and average duration of back pain was 11. VOL. Average intensity of pain was 4. Recruitment We placed flyers and posters in inner-city primary care clinics and advertisements in newsletters for university and medical center employees.6 P=0. infectious disease.1 4.5 P=0. and severe concurrent illness to obtain a study population suffering from non-specific mechanical LBP.7 P=0.8 39. (4) pharmaceutical drug usage for back pain. inflammatory spondyloarthropathies. systemic or visceral causes of pain. well-defined cause of back pain such as spinal stenosis (n=15). There were no differences between groups on back pain-specific instruments (Roland Morris scores and Oswestry Index. Outcome measures were assessed at baseline and at 1.4 P=0. To better ascertain how clinical response is modulated by baseline expectation.71 STAI (Anxiety) 7.1 6. As randomization in smaller trials has a higher probability to result in significant group differences that can make it difficult to compare the outcome measures. or regular participation (>1/week) in Iyengar yoga for the past 3 months. Success of Stratified Randomization Fifty-two participants were randomized using blocks of 6 and resulting in groups of close to equal size: 28 were randomized to Yoga therapy and 24 were randomly assigned to wait-control delayed Yoga therapy. and healthcare utilization (number of back pain-related outpatient visits). to have made at least 3 visits to any health provider for nonspecific mechanical low back pain in the previous 12 months. In addition.000 $55.2 out of 10 point maximum score (Table 3). we ascertained baseline expectation of improvement from yoga and found no differences between groups as well (Table 3). and 6 months follow-up. Stratification criteria were provided to the project coordinator so that she was able to randomize each participant within the appropriate stratification group. and unwillingness to delay yoga intervention if randomized to wait-list control group (n=8). 52 (71%) were randomized to 1of 2 groups in the study. vertebral fracture or dislocation.Inclusion and Exclusion Criteria Inclusion criteria required participants to be 18-65 years of age.0 P=0. concurrent yoga practice (n=9).13 -average 7.86 CES-Depression 41.59 Oswestry Index 38.9 P=0.92 43. education. and adherence to class and home-based practice. Actual assignment to appropriate treatment arms was performed by the research coordinator according to a pre-established randomization list kept in a locked file cabinet. TABLE 2 Baseline Demographic Characteristics Wait-list (N=24) Statistical Value Yoga (N=28) Characteristic P=0.4 3. participants were excluded with pregnancy.5 Age P= 0.08). RESULTS Feasibility of Recruitment Recruitment for the study began on January 10. acute radicular syndrome or severe neurological signs. 2003 and ended on March 27. To increase rigor and strength of our study.
many subjects had limited familiarity with yoga. 9. Complement Their Med. Raju PS. Nora Burnett. this is the first yoga trial published using an expert panel to develop a yoga intervention through consensus. it required the intervention to follow a general sequence of poses. 10. and Ramanand Patel) for their willingness to work collaboratively to develop the yoga protocol. Hatha Yoga for Chronic Lower Back Pain ALTERNATIVE THERAPIES. 1989. Kabat-Zinn J. Outcome measures for low back pain research. Furthermore.26(22):2504-13.. To optimize adherence. and psycho-emotional equilibrium. Elise Miller. 2000. Liu GG. This pilot study completed recruitment in less than 3 months. 12. Therapeutic Application of Iyengar Yoga for Healing Chronic Low Back Pain. Julia Lorimer. Pietrobon R. An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: theoretical considerations and preliminary results. References 1. Roger Cole. Jauhiainen M. Malmivaara A. 2002 8. The semi-structured format limited the universe of possible poses to 28 with specified poses to be performed on a daily basis. 1982. and awareness of the physical body while practicing yoga. the precise mechanism by which yoga might have clinical benefit has not yet been elucidated.iayt. Nora Burnett. Waddell G. Coordination of large numbers of research subjects for specific class times requires considerable time and staffing. Spine. Yoga.29(1):79-86. Particular attention and research staffing must be allocated to scheduling of the intervention. 2003. Deyo RA. and of recruiting participants expeditiously. these participants attended 15 (66%) classes over the 3-month trial period. 2001. demonstrating the feasibility of recruiting volunteers to participate in a randomized controlled trial for yoga and back pain. Spine. CONCLUSION To the best of our knowledge. 3. this report is the first description of a randomized clinical trial published on the effect of yoga for back pain. Luo X. 13. A web-based reference list. Steinberg. discussion 2513-4. Il. 1998 Sep 15. A proposal for standardized use. standardization of teacher training and certification. Ernst E. different schools of yoga. 7. Furthermore. Koes B. Spine. In conclusion. A study of the natural history of back pain. Acknowledgments We are extremely grateful to the expert panel members (Kathy Alef. Lower Lake CA. Deyo RA. Obstacles to research in complementary and alternative medicine. Evlaleah Howard. Morris R. 8(2): 141-150. This pilot study demonstrated the feasibility of developing a yoga protocol by consensus of an expert panel of nationally and internationally recognized senior yoga teachers. this trial provides evidence of the feasibility of creating a yoga protocol through expert panel consensus. 13: 55-67. 2. 2001. and J. Feuerstein T. Ostelo R. 5. 6. Preliminary results suggest moderate adherence to the yoga classes. Multidisciplinary biopsychosocial rehabilitation for subacute low back pain among working age adults. Which complementary and alternative therapies benefit which conditions? A survey of the opinions of 223 professional organizations. Effects of yoga practices in non-specific low back pain. et al. 2000: p. Clinical Proceedings of NIMS. Furthermore. 2 83 . 2001 Nov 15. Clinical guidelines for the management of low back pain in primary care: an international comparison. Natural Standard (www. 10. Sun SX.pdf. Sampth K. 4. van Tulder M. and Kathy Alef ). Judith Lasater. 2003. Spine.Adherence to the Yoga Intervention Overall. An evidence-based summary monograph.26(13):1418-24. Vidyasagar JVS. http://www. Yoga and the back. Battie M. Karjalainen K.com). Hurri H. LaGrange. 25(19): 2552. 2004. Prasad BN. Cherkin DC. 16. Fairbank J.org/back. Anonymous. to our knowledge. 14. On average. Koes BW. Roland M. NO. 64% of participants assigned to receive the immediate yoga intervention attended yoga classes throughout the 3 month intervention period. Kim Burton A. van Tulder MW. and frequent use of assistant devices (props). Spine.(2):CD002193.23(18):2003-13. 1999. Should yoga practice be effective for reducing pain and disability among people with non-specific mechanical low back pain. VOL. Part I: Development of a reliable and sensitive measure of disability in low-back pain. Future trials should incorporate an evaluation of potential mechanisms into the clinical trial. Gatchel RE. Andersson GB. Data collection for the 3-month time interval was completed by 84% of all participants without differences between groups. relaxation response. Compendium of Outcome Instruments for Assessment and Research of Spinal Disorders. Med J Aust. The dramatic increase in popularity of yoga combined with the high prevalence of chronic low back pain may have facilitated the recruitment process. Ernst E. This semi-structured format addressed both the need to remain within a classical individualized practice and to provide a protocol that can be replicated by other scientists. We wish to express our gratitude to the yoga instructors who worked tirelessly to individualize the implementation of the yoga protocol for the benefit of the research participants suffering with back pain (Anne Saliou. Reddy MV. 354(9178): 581-5. Intern J Yoga Therapy. Since ongoing yoga practice was an exclusion criteria for our study. The process of arriving at consensus required considerable collaboration between panel members. MAR/APR 2004. Long L. 4: 160-164. Sherman KJ. 2003. Hey L. The protocol was developed by consensus among senior teachers of the Iyengar method and therefore reflects a protocol that is generalizable to the general practice of the Iyengar method for people with non-specific mechanical low back pain. 179(6): 279-280. This process is significantly more complicated than traditional trials that evaluate interventions that require the subject to meet with a provider or obtain a 3 month supply of medicines at the dispensing pharmacy. 15. attention to posture and alignment. Part II: Development of guidelines for trials of treatment in primary care. Beurskens AJ. Williams. Estimates and patterns of direct healthcare expenditures among individuals with back pain in the United States. Koepsell TD. It is theorized that potential mechanisms might include physical body alignment and posture. Roine R. Kalauokalani D. Methodological challenges have been outlined and discussed to facilitate future research by investigators interested in conducting clinical trials on the therapeutic application of yoga for medical conditions. Revised Oswestry Disability questionnaire. and different yoga poses may provide varying clinical effect. Spine. each with unique approaches. future studies may consider providing a demonstration lecture to volunteers eligible for the study prior to randomization. Lessons from a trial of acupuncture and massage for low back pain: patient expectations and treatment effects. Lancet. K. We selected the Iyengar yoga method for the back pain population because of its widespread availability. Huntley A. Petronis. 9(3): 178-85. North American Spine Society. This study demarcates the beginning stages of conducting rigorous clinical effectiveness research in the therapeutic application of yoga for back pain. Gen Hosp Psychiatry. and abide by a general theme of including instruction on breath. Publication of Yoga Research and Education Center. There are multiple schools of yoga. 2001 Jul 1. 4(1): 33-47. 11. Cochrane Database Syst Rev.naturalstandard. This introductory experience might improve adherence to the intervention by educating potential subjects with little knowledge of yoga about the general theory and practice of this method and informing potential participants of the significant active participation and self-care commitment required of the research subjects in the yoga intervention. Jayshankar M.1983. Epidemiological features of chronic low-back pain. L.
Harley A. The authors are: Bradly P. Roger J. Wolf Mehling. Question 8 should read: Select the following incorrect statement.4 40. 2004. MA. Feasibility of Conducting a Clinical Trial on Hatha Yoga for Chronic Low Back Pain: Methodological Lessons (Altern Ther Health Med. PhD . NO. 10(2): 80-83. Question 7 should read: Interventions with potential benefit for bones include the following except: (D) Flaxseed.0 39. MD . Michael Acree. Avins A. et al. 2 .8 41. Goldberg. MD. Avins MD . PhD .59 P=0.13 P=0.) should have appeared as follows: TABLE 3 Baseline Clinical Characteristics Characteristic Yoga Wait-list (N=28) N= (24) Statistical Value Visual Analog Pain -average -maximum Pain duration (years) Roland-Morris Oswestry Index CES-Depression STAI State Anxiety STAI Trait Anxiety Global Expectation 4.10(2):26-34) were incorrect. MAR/APR 2004.68 84 ALTERNATIVE THERAPIES. Judith Hanson Lasater. Genetic components of osteoporosis are: (B) attributed to a single gene. Erratum Table 3 in Jacobs B.erratum Correction There was a discrepancy in the author listings of Feasibility of Conducting a Clinical Trial on Hatha Yoga for Chronic Low Back Pain: Methodological Lesson (Altern Ther Health Med. Mehling W. Riley. 10.86 P=0. Cole.4 7. Several answers provided for the continuing medical education lesson.24 P=0.71 P=0.3 7. Andrew L.6 38. The answer for question 5 is (B) is inadequate in US girls and women. MPH. 2004.0 15.9 3.4 14. MD.30 P=0. and Stephanie Maurer.1 11. DO . VOL. David S.0 6.34 P=0.1 12.0 7.6 11.84 P=0. PhD . An Overview of Osteoporosis (Altern Ther Health Med. Jacobs. PT .9 6. MPH .10(2):80-83).5 4.7 P=0. 2004.9 10.
This research integrates clinical trials investigating the application of Hatha yoga with ongoing patient care and education.2261 4.research letter HATHA YOGA AND MEDITATION IN PATIENTS WITH POST-POLIO SYNDROME William DeMayo. it has been shown that milder.8 leading some experts to suggest that the most viable treatment presently available involves reassurance and non-fatiguing exercise.4539 .004 0. This publication was made possible by sub award 0000076643 from the Uniformed Services University (USU) of the Health Sciences. PPS refers to the new neuromuscular symptoms that occur after at least 15 years of stability in patients with prior acute paralytic poliomyelitis.4194 . (303) 440-7446. Randomized clinical trials investigating drug treatments (eg. e-mail.0001 Reprint requests: InnoVision Health Media. MAR/APR 2004. Barbara Duryea.5671 3. The results of this clinical trial will be used to develop a longitudinal data collection effort integrating research and clinical trials investigating the applications of Hatha yoga in with ongoing patient care and education.7637 18. Barbara Duryea. NM. or will experience. CO 80301. MD PhD MD William DeMayo. PA followed by 12 weeks of home practice with a video specifically developed for this clinical trial.3113 2.3391 61.7204 1. is a professor and dean of resesarch at Southern California University of the Health Sciences.1739 5.4 and anticholinesterases5) for PPS patients have to date proved disappointing and there have also been reports that strenuous exercise in PPS patients may actually result in a decrease in muscular strength. Most patients also suffer from significant fatigue.001 0.009 0. PPS.001 0. The cardinal feature of PPS is new onset of weakness not otherwise explicable.9 This study enrolled 23 patients. phone.081 0. .4824 P-value 0. Betsy Singh.7109 49. (Paired Samples Statistics) Baseline (1st day prior to Intervention) VAS Pain Yoga Self-Efficacy Fatigue Severity Scale Fatigue Impact Scale VAS fatigue VAS weakness N 23 23 23 23 23 23 Mean 5.9060 SEM . . Albuquerque.3652 73.7391 51. MD. Boulder. David Riley.1 It is estimated that approximately 300. and the editor-in-chief of Alternative Therapies in Health and Medicine.6 million polio survivors in the United States have.Foundation.0761 SD 2. All patients participated in a 5 day retreat in Johnstown.3913 6.000 of the estimated 1.2391 5. Betsy Singh.2658 5.2572 6.1174 End of Intervention SD 2.7391 4.4819 .8071 . 24 ALTERNATIVE THERAPIES.3974 N 23 23 23 23 23 23 Mean 4.8497 2.2335 30. less extreme forms of exercise may improve muscular strength and fatigue7. is a clinical associate professor at the University of New Mexico Medical School.2748 27.9035 .2 amantadine. or the Henry M.com.0113 1. The data was analyzed via one-way repeated measures analysis of variance in order to estimate an effect size to TABLE 1 Pair wise comparison between baseline (first day of retreat) and last day of retreat. 10.5763 3. (303) 440-7402. Its contents are solely the responsibility of the authors and do not necessarily represent the offical views of USU.3332 . Suite 205. David Riley.2522 6. 2995 Wilderness Place.5645 1. firstname.lastname@example.org 16.3 pyridostegmine. PhD.3137 SEM . 2 Yoga and Meditation in Patients With Post-Polio Syndrome . is medical director/PI for the Conemaugh Post-Polio Center. prednisone.3730 2. MD.6 However. the US Department of Defense. NO. C onemaugh Health System has completed a preliminary outcome study evaluating the benefits of Hatha yoga and meditation in patients with post-polio syndrome (PPS). VOL. is the project coordinator of research and development for the Conemaugh Health System’s Regional Neuroscience Center. fax.
8.753:402-4.2381 6. As for the baseline and 12 week comparison. 1991. et al.3258 7.4393 2. placebo-controlled trial of high-dose Prednisone for the treatment of Post-Poliomyelitis Syndrome. 5.753:296-302.5641 18. Subsequent studies will be designed so that multiple centers can be involved and data can be pooled to produce a hardy set for subsequent analyses.2976 SD 2. Cashman NR. VOL.9750 5.1637 . Why drugs fail in postpolio syndrome: lessons from another clinical trial. Dambrosia JM. A multicenter.5501 1. Neurology. Lehman JAR. Ann N Y Acad Sci.019 0. Spector SA. 7. 4. Anticholinesterases in post-polio syndrome.22:182-194. NO. These results showed significant improvements in a patient population where a lack of deterioration is often viewed as success.5238 6. Trojan Da. placebo-controlled trial of Amantadine for the treatment of fatigue in patients with the post-polio Syndrome. A clinical and experimental study of the effects of exercise on motor weakness in neurological disease. last day of retreat and 12 weeks after the retreat. 1995.3907 1. Yildiz E. Impact of Hatha Yoga on Smoking Behavior ALTERNATIVE THERAPIES.5595 4. Ann N Y Acad Sci.4095 66.53: 1925-1933. For all outcomes.002 0.8000 4. A double-blind. These patients improved and at the end of 12 weeks they were actively involved in self-care.5143 54.753:296-302. significant differences were found between baseline and last day of retreat (see Table 1).4133 SE M . Dalakas MC. A double-blind. A preliminary report. Dinsmore S. 6. 1999.4571 74.TABLE 2 Pair wise comparison between baseline (first day of retreat) and 12 weeks post study. Ann N Y Acad Sci.9463 27. Post-Polio Syndrome.753:303-13. Ann N Y Acad Sci. (Paired Samples Statistics) Baseline (1st day prior to Intervention) VAS Pain Yoga Self-Efficacy Fatigue Severity Scale Fatigue Impact Scale VAS fatigue VAS weakness N 21 20 21 21 21 21 Mean 5.3383 . 1995. Muscle conditioning in late poliomyelitis.8976 49. 3. 1999.9476 4.4919 .2065 6.8282 2. 10. MAR/APR 2004.2381 4. 1995. Patients were assessed at 3 time periods: baseline (first day of retreat).72: 11-14. Neurology. 2001. Effect of strength training in patients with post-polio syndrome.5425 P-value 0. Curr Opin Rheumatol.001 0. except visual analogue scale (VAS) fatigue. Collet JP.4862 SEM . randomized.53: 1166-1167.2540 2.4931 32. 9. Dalakas MC. Stein DP. Trojan DA.005 0. 2. significant differences were found for VAS measures as well as Yoga Self Efficacy and Fatigue scales (see Table 2).7857 SD 2. Dalakas MC. 1959.3084 N 21 20 21 21 21 21 12 Weeks Post Intervention Mean 4.0132 11.2:901-907.0588 .1276 . Einarsonn G. Arch Phys Med Rehabil. J Neurol Neurosurg Psychiatry.5470 . Dalakas M. 2 25 . References 1. Dambrosia J.013 0.008 guide a sample size/power analysis for subsequent clinical trials.7649 1. double-blind trial of pyridostegmine in post-polio syndrome. Seven outcome measures were used to assess patient response to the interventions and compare reliability among the scales used. Gordon PL. 1995 .4594 . Shapiro S et al.
why is it happening now. the utilization of inpatient versus outpatient services. 20 ALTERNATIVE THERAPIES. CO 80301. The general interest in yoga and the specific interest in Hatha yoga in the western world has been slowly growing for the past 30 years and exploded over the past 5 years. 2 Hatha Yoga and the Treatment of Illness . back bends. breathing exercises known as pranayama. (303) 440-7402. Boulder. The controlled breathing of pranayama helps the mind focus and is an important component of relaxation—a modulator of autonomic nervous system function. Hatha yoga is part of the non-sectarian philosophical system of yoga that emerged from the Indian culture approximately 4. (303) 440-7446. and have failed to contain escalating costs reflected in the increasing percentage of the nation’s gross domestic product. all strengthen the body and increasing flexibility in a controlled fashion. Yoga Sutras. the meditative aspect of yoga. MAR/APR 2004. asanas or postures.com. VOL. is a clinical associate professor at the University of New Mexico Medical School. Finally these sorts of meditative exercises seem to be able to stimulate the limbic system In this issue of Alternative Therapies in Health and Medicine. pranayama (breathing exercises).2 Finally. Secondly the simultaneous activation of antagonistic neuromuscular systems such as flexion and extension and intrasfusal and golgi tendonorgan feedback may provide a way to maintain range of motion and increased the relaxation response in the neuromuscular system. phone.1 For more than a decade. Robert Saper reveals the extent of use of Hatha yoga in the general population using data from a 1998 national survey conducted by the Center for Complementary Medicine Research at Harvard University. calms and focuses the mind. clinical trial.3. Dhyana. and what are implications for healthcare.1 An estimated 7. NO. these attempts have not improved patient satisfaction. 10. MD. the nature of the contact between clinician and patient.000 years ago and was designed to foster the attainment of self-awareness. in two clinical trials—one on depression and one on low back pain—clinical trial data is presented. were designed to purify the body in preparation for higher states of consciousness and meditation. This is an important start in the rigorous evaluation of how the discipline of Hatha yoga may be useful in a medical setting. Western physiological explanations of how Hatha yoga might be effective in the treatment of illness focuses on several points. e-mail. Suite 205. Several systematic texts on Hatha yoga appeared between the 6th and 15th century AD including the Hatha Yoga Pradipika by Swatmarama. and meditation—all of which are usually integrated with one another. its major principles were first systematically reviewed in the classic text. he American healthcare system continues in a crisis mode. What is this all about. the postures of Hatha yoga. Originally. and Gherand Samhita by Gherand. open-label.4 million Americans used yoga during the previous year for both wellness and specific health issues. 2995 Wilderness Place. The Yoga Journal estimates that more than 15 million people attended a yoga class in the United States alone during the past year. First is the modulation of autonomic nervous system tone. and the editor-in-chief of Alternative Therapies in Health and Medicine. forward bends.commentary HATHA YOGA AND THE Riley.4 Patients with chronic low back pain showed improved balance and flexibility in functional measurement scores as well as a decrease in depression and in a study on the effects of yoga in depression subjects attended two one hour yoga classes for 5 consecutive weeks and reported significant decreases in their levels of anxiety and depression which also correlated with higher levels of morning cortisol. and in this hypothesis paper these authors used this clinical trial as a springboard to discuss the design and methodological challenges of research in this area. niyama or purification (such as fasting). have left physicians and nurses feeling disenfranchised. balancing. and Hatharatnavali by Srinivasabhatta Mahayogindra. Hatha yoga commonly has 3 ingredients. Brad Jacobs from the University of California at San Francisco conducted a randomized. by Patanjali in 200 BC. which have become so popular in the west. and reimbursement for the care. The postures of Hatha yoga involve standing. focusing on Hatha yoga. In the main. there have been multiple attempts to transform the manner by which patients select their clinician. postures known as asana. NM. two-arm.2 This month’s issue of Alternative Therapies in Health and Medicine focuses on yoga. TREATMENT OF ILLNESS David MD David Riley. These 3 ingredients of Hatha yoga are inter-connected and complement one another. and twists. Reprint requests: InnoVision Health Media. the Goraksha Samhita by Yogi Gorakhnath. fax. Albuquerque. T and then various stages of meditation leading to Samadhi—a state where one merges with the object of meditation. alternative-therapies@innerdoorway. which commonly means a reduction in sympathetic tone. wait-list controlled. Even though there are references to the postures of Hatha yoga dating back to the 6th century BC in the Upanishads. The practice of Hatha yoga in these texts often include a series of steps beginning with yama or moral commandments.
three of the primary schools are Iyengar yoga associated with BKS Iyenbar. 4. VOL. and the therapeutic possibilities with Hatha yoga. 2004. Eissler J. References 1. Myers H. For therapeutic purposes. 2. meditation. 2004. Jacobs B. et al. Galantino ML. 3. and Ashtanga yoga in known for its vigorous flow in a standardized series of posture. Eisenberg D. Iyengar yoga and Viniyoga are probably most appropriate for those with specific medical conditions. There are many styles of Hatha yoga available today. Altern Ther Health Med. and communication skills to adapt the therapy to the patient. Bikram yoga.10(2):56-59. Prevalence and Patterns of Adult Yoga Use in the United States: Results of a National Survey. breathing exercises and relaxation or meditation into a one to two hour yoga class. Altern Ther Health Med. 2004. 10. Bzdewka T.10(2): 80-83. Feasibility of conducting a clinical trial on Hatha yoga for Chronic Low Back Pain:Methodological lessons. particularly since most yoga practitioners do not have medical qualifications. Altern Ther Health Med. A Yoga Intervention for Young Adults with Elevated Symptoms of Depression. Saper R. et al.10(2)44-49. patience. Altern Ther Health Med. Mehling W. NO. Woolery A. Viniyoga associated with TKV Desikachar. Krishnamacharya and each of these schools pay great attention to the postures. and Ashtanga yoga associated with Pattabhi Jois. is probably not an appropriate point of departure for a wide variety of patients such as those suffering from medical problems exacerbated by heat. What does a practitioner need to know before referring a patient to a Hatha yoga class? Almost any program of Hatha yoga will incorporate postures. Zeltzer L. Certified yoga therapists with experience in both teaching yoga and working with patients are becoming more common as Hatha yoga is more frequently integrated with other medical therapies for a range of illnesses and research studies are conducted on its potential applications. MAR/APR 2004. The Impact of Modified Hatha Yoga on Chronic Low Back Pain: A Pilot Study. There are of course many other styles of yoga ranging from Kundalini yoga to Kripalu and Integral yoga. with its intense heat.Given the interest in the general population in Hatha yoga and the emergence of information from clinical trials on its possible usefulness it appears that Hatha yoga can probably be adapted for many patients. 2 21 . The challenge is finding a yoga teacher with the experience. It is important for healthcare providers to remember that most yoga instructors are not medical professionals and that no state licensing is required to teach Hatha yoga. Viniyoga is known of its attention to the individualized nature of the yoga practice. Goldberg H. 2004.10(2):60-63. The Iyengar system of Hatha yoga is known for its emphasis on technical alignment. All of these styles of Hatha yoga lead back to the Hatha yoga master Sri T. Davis R. Certification can be obtained through some yoga schools and some yoga traditions and it is best to seek out a teacher who has at least several years of teaching experience and who continues to study and practice yoga regularly. breathing. Hatha Yoga and the Treatment of Illness ALTERNATIVE THERAPIES. Sternlieb B.
5 [ 95% CI 1.8] and 2. VOL. we analyzed previously collected but unreported data on yoga use from our 1998 national survey of American adult complementary and alternative medicine (CAM) use.10(2)44-49. e-mail.0]). Davis. MA.) oga originated in India more than 2. If there was more than one adult member in the household. 2995 Wilderness Place. CO 80301. 7. MD. MA. 10. 2 Prevalence and Patterns of Adult Yoga Use in the United States . Department of Medicine. and physical directives. Osher Institute.original research PREVALENCE AND PATTERNS OF ADULT YOGA USE IN THE UNITED STATES: RESULTS OF ARoger B. MPH MD Robert B.3-5. is professor and chairman. Beth Israel Deaconess Medical Center. is a research fellow at the Division for Research and Education in Complementary and Integrative Medical Therapies. ScD MD. Between November 1997 and February 1998.7-3. Roger B. Boston. the target respondent for the interview was randomly selected. ScD.5]).3 [1. NATIONAL SURVEY Robert B.2 [1. Beth Israel Deaconess Medical Center.com. MPH. education beyond high school (2. college educated (68% vs. Harvard Medical School. We described the survey to respondents as a study by Harvard Medical School about the general health practices of Americans. and urban dwellers (93% vs. Data were weighted according to geographical Y 44 ALTERNATIVE THERAPIES. (303) 440-7446. Background • Although yoga appears to be popular in the United States. to the best of our knowledge. Osher Institute. MD. there have been no published studies of the prevalence and patterns of yoga use in the United States. moral. MD. NO. 48% for health conditions.000 years ago. MD. Methods • In 1998 we surveyed by telephone a nationally representative sample of 2055 English-speaking U. (Altern Their Health Med.4-3. adults (60% weighted response rate) regarding yoga use. Boston. Institutionalized individuals.12 Despite yoga’s apparent popularity. Recently featured in the lay press2-5 and popularized by entertainment6 and sports7 celebrities. there are no published studies on yoga’s prevalence or patterns of use. we conducted a nationally representative telephone survey of English-speaking adults.5]). fax.11 A 2000 survey of health clubs conducted by a fitness trade organization found yoga to be one of the fastest growing class offerings. and 21% specifically for back or neck pain. 2004. non-English speakers.5% used yoga at least once in their lifetime and 3. David M. Harvard Medical School and the Division of General Medicine and Primary Care. Department of Family Medicine. Russell S. is associate professor in the Division for Research and Education in Complementary and Integrative Medical Therapies. Results • Of the respondents. Yoga was used for both wellness and specific health conditions often with perceived helpfulness and without expenditure. MPH. David M.0 million American adults had used yoga at least once in their lifetime and 7. Factors independently associated with yoga use at least once included female gender (OR 2. percent felt yoga was very or somewhat helpful and 76% did not report spending money related to their yoga. . Respondents who used yoga at least once were more likely than non-users to be female (68% vs. Suite 205. Of respondents using yoga in the previous 12 months. yoga is being marketed to a variety of patient populations such as back pain sufferers. Ninety Reprint requests: InnoVision Health Media. MAR/APR 2004. residing in large and small metropolitan areas compared to non-metropolitan areas (3. (303) 440-7402. Conclusions • In 1998 an estimated 15. 74%). . 51%). Saper. In order to better understand this phenomenon.S. Phillips. phone. respectively). the purpose of yoga practice was to attain “spiritual self-realization.4 million during the previous year. MD.13 METHODS Survey Design The survey structure has been described previously. Boulder.”1 The practice of yoga postures (asanas) and breathing techniques (pranayama) began to become popular in the United States during the 1960s. Phillips. or persons without telephones were excluded.8 [1. In its original form. is associate professor and director of the Division for Research and Education in Complementary and Integrative Medical Therapies. Saper.8]). alternative-therapies@innerdoorway. MD.9 children. and use of other CAM therapies (5. Eisenberg.4-4.8]. 45%). Davis. Department of Medicine. MPH.8% used yoga in the previous 12 months. is associate professor and Director of the Division of General Medicine and Primary Care. Harvard Medical School. Larry Culpepper.7 [1. yoga was a complex system of spiritual. 64% reported using yoga for wellness. Eisenberg.8 pregnant women.7-10. Boston University. Translated from Sanskrit to mean unify.10 and senior citizens.8-7. Russell S. baby boomer age group (ages 34-53) compared to pre-baby boomers (≥ 54 (2.13 and will be briefly reviewed here.3 [2. Osher Institute. Larry Culpepper.
“In your lifetime have you ever used yoga?” Respondents answering “yes” were defined as “yoga users. self-help groups. 2.” A subset of current yoga users (“current yoga user subset”) was selected for further questioning about their yoga use. illness prevention. number of adults in household. Members of the current yoga user subset were asked the following questions about their yoga: (1) “Have you used yoga for wellness (ie. and if not. whether a financial incentive was necessary for participation. imagery. All survey respondents were asked. massage. maintaining health and vitality)?” (2) “For which health conditions. if a current yoga user used 6 CAM therapies including yoga. Sociodemographic information. We divided annual income into FIGURE 1 Interview Flowchart Prevalence and Patterns of Adult Yoga Use in the United States ALTERNATIVE THERAPIES. Age was categorized into 3 groups according to Kessler et al: 16 post-baby boomers (ages 18-33. and to reflect the agesex distribution of the US adult population. The study was approved by the appropriate Institutional Review Board. Similarly. Data Collection Figure 1 presents an overview of how we identified and defined the use of yoga. very good. good. biofeedback. born < 1945).” Those answering “no” were defined as “yoga non-users. folk remedies. classes. the reasons for nondisclosure. SUDAAN software 14 was used for all analyses and sampling weights were applied to provide estimates for the US adult population.5. or poor). and self-reported health conditions in the past 12 months were collected for all respondents. fair. born 1965-1980). Of the 4. did you spend money for a “professional for your yoga” and/or for “books. and lifestyle diets such as macrobiotics.75. how helpful has yoga been for your [health condition] in the past 12 months?” (4) In the past 12 months. born 1945-1964). All current yoga users who used three or fewer CAM therapies (including yoga) in the previous 12 months were included in the current yoga user subset.” Respondents answering “no” were “past yoga users. commercial weight loss programs. if a current yoga user used a total of 4 CAM therapies including yoga. 10.005 completed the survey for a 60% weighted response rate. the probability of being selected for the current yoga user subset was 0. hypnosis. mega-vitamins. perceived health status (excellent. we asked whether they disclosed their yoga use to their doctor. VOL. or any other items related to yoga?” (5) For those yoga users who had medical doctors. aromatherapy. Population estimates were extrapolated from 1998 Census Bureau data.” We asked all yoga users whether yoga was used in the previous 12 months.15 The chi-square test of independence was used to compare yoga users to yoga non-users and current to past yoga users. For example. equipment. homeopathy. naturopathy. have you used yoga in the past 12 months?” (3) “In general.167 eligible individuals contacted. Yoga users were asked about their perceptions of CAM relative to conventional medicine. For current yoga users who used more than 3 CAM therapies. Respondents answering “yes” were defined as “current yoga users. and pre-baby boomers (age ≥ 54. NO. the probability of being selected was 0. MAR/APR 2004. herbs. Data Analysis Due to the complex sampling survey design. baby boomers (ages 34-53. the probability of being selected for the subset was inversely proportional to the total number of CAM therapies used. chiropractic. if any. 2 45 . energy healing. relaxation techniques. We also asked about the use of other CAM therapies including acupuncture.location.
0 (4. We then employed a forward selection strategy with a criterion of P<.d.1) 31.0).d. RESULTS Prevalence of Yoga Use Yoga use at least once in their lifetime was reported by 7. $20.1 million) Non-metro area (<50.0) 16.2 (1.1) 26.0004 28.6 (4.d.5%.0 (1. 1.d. or poor).S.999.2) Age group 18-33 yrs (post-baby boom) 34-53 yrs (baby boomers) ≥ 54 yrs (pre-baby boom) Gender Female Education > High school education Income < $20. and 7.000-$49. and to reflect the age-sex distribution of the U. and depression (P=. 13. Islamic.7 (1.0 (1.5%. yoga users were more likely than yoga non-users to live in metropolitan areas.000-$49. Table 1 shows sociodemographic factors for yoga users compared to yoga non-users.d.2) 28.0001 60.7) 15.0) .6 (4.8 (1.2) 9.6) 44.7)* % (s.29 71. Jewish.5 (4.48 20.000. adult population. and least prevalent in the Midwest. Religious preference was divided into Christian (Catholic and Protestant). whether a financial incentive was needed for participation.2) 20.4 (1.18 We used multivariable logistic regression models to identify factors independently associated with yoga use.1) 67.8 (4.2) .01). 4.2) .3) .3) 16.5 (3. 2 Prevalence and Patterns of Adult Yoga Use in the United States .1) of the total respondents.1) 32. employment status.3) . health conditions independently associated with yoga use were identified after controlling for sociodemographic factors. we did not find race.3 (4. fair. Using Census Bureau estimates of 200 million adults living in the US in 1998.1 (4. 1.8 (3.d. VOL. 0.<$20. Past yoga users were 3.01).22 80.0 (1. Lastly.4) 42.2) 25. 12.8 (4.0 (1.2) yoga users. or health insurance status to be significantly different between yoga users and yoga non-users.1 (1.6 (3. Lastly.d.002 67. Current yoga users were 3.0) 23.1) 13. anxiety (P=.9) 25.5%) of the total respondents.3) 35. Whereas less than two-thirds of yoga 46 ALTERNATIVE THERAPIES.d.4 (3. number of adults in the household. they are also more likely than nonusers to report a variety of health conditions such as back or neck pain (P=. While 8. Hindu).5) 7.2) .6 million (s.2 (1. Of these yoga users.5% (s.3) <. and were less likely to report a Christian religion.2) 7.000) using the US Department of Agriculture rural-urban continuum codes. MAR/APR 2004.4).2) 54.6 (4.20 in univariate analysis were candidates for the model.4 million (s.9) 35. and education into beyond high school or high school or less.0 (0. 7. 10.d. other (eg.6 (4. 4. Urbanicity was stratified into large metropolitan areas (> 1 million). These models were then applied to current yoga users to assess whether the same factors were associated with current use of yoga.999 ≥ $50.8% of those reporting no health conditions used yoga (P<0.1 (1.8% (s.7% (s. TABLE 1 Sociodemographic Factors for Yoga Users and Yoga Non-users Yoga Users Yoga Non-users P-value (n=154.4) 42.000-1 million). 0.6). Table 3 compares the lifetime use of other CAM therapies by yoga users and yoga non-users.2) .3) .01).13. or none.) .3) 32. Of the respondents.2) 32.2) . income.000 .05 for inclusion in the final model.02).0001 67.4% of those reporting at least one associated health condition were yoga users.4 (1.0) of the total survey respondents (weighted n=2055.d.2) 43. or >$50. Although users are more likely than non-users to report their health as excellent or very good (P=.7 (4.4 (4.2) 23.0 years (s.6 (1.9 years (s.7) . The self-reported health status and associated health conditions for yoga users and yoga non-users are compared in Table 2.2 (1. respectively.93 76.04 31.4) 42. Yoga users were more likely to be baby boomers. The mean age at first use of yoga was 27.2 (1.5 (1.3% (weighted n=5.4 (4.03). Age group and gender were included in the model a priori for their clinical and epidemiological importance. 1. weighted n=78.7) 85.03). lung problems (P=.3 (3.4 (4. Buddhist. Factors associated with Yoga Use: Univariate Analysis The mean age of yoga users was 43.9) 24.1 (4. 0. A second model was built using a similar strategy to identify other CAM therapies independently associated with yoga use after controlling for sociodemographic factors.2) 46.7 (3.2 (1.000) Marital Status Currently married Children < 18 yrs old living in household Yes Employment status Employed *Number of yoga users and yoga non-users are weighted for geographical distribution. NO.6 (1. We categorized race into white or non-white. small metropolitan areas (50. weighted n=154.0) 19.17 Perceived general health status was dichotomized into high (excellent or very good) or low (good.5 (1.9) reported yoga use during the previous 12 months (current yoga users). Sociodemographic factors associated with yoga use at P<0.8 (1. 0.000 as done previously.3) did not answer the question regarding yoga use.0)* (n=1895. Furthermore.2) 29.0 million (s. female.0) 77.3) 84.02 36.2 (2.0 (1. weighted n=75. or non-metropolitan areas (≤ 50.1) 40.2 (4.9 (1. Yoga use was most prevalent in the Northeastern and Western US.6%. college educated.3% (s.002 29.000 $20.0) current yoga users.0 (0.8 (2.d.000 Insurance Status Has health insurance Race White Non-white Religious preference Christian Other None Region West Midwest Northeast South Urbanicity Large metro area (>1 million) Small metro area (50.0) past yoga users.15 these data extrapolate to an estimated 15.) % (s.1) 50. The youngest and oldest age at first use were 7 and 73. 49.0002 68.
0001 <. books.0)* % (s.7) 16. and herbs. Lung disease failed to reach significance for the current yoga users (data not shown).0) Massage 44.d.3) Naturopathy P-value .8 (4.1 (4.9) 10.4 (0.3) Any CAM use in lifetime other than yoga 93.0%).7) 5. <.0) 24. The most common CAM therapies tried by yoga users were relaxation techniques.4) Biofeedback 8.9% for specific health conditions (respondents could answer yes to either or both).2 (1. In this subset.09 .55 .5) 35.4 (4.0001 .03 <.0) 17.1) 9.5 (1. and to reflect the age-sex distribution of the US adult population.2 (0.90 .002 <.5) Homeopathy 24. the sociodemographic factors listed in Table 4 all remained statistically significant with the exception of small metropolitan areas.0 (2.9 (2.9) 8. Current yoga users and past yoga users were also similar in respect to health status and CAM utilization factors (data not shown).3) 16. the low absolute Prevalence and Patterns of Adult Yoga Use in the United States ALTERNATIVE THERAPIES.6) Megavitamins 23.4) 9. The overwhelming majority (90%) felt yoga was very or somewhat helpful for their health conditions. classes.) % (s.2) 10.8 (1.0001 <. 62%.5 (3. Factors associated with Yoga Use: Multivariable Analysis Factors independently associated with being a yoga user are shown in Table 4. Specific CAM therapies that were independent correlates of yoga use were relaxation techniques.9) Herbs 33.4 (0.7 (1.7) 6. yoga instructors.2 (0.0001 <.4 (0. number of adults in the household.0001 . Of the current yoga user subset.6%) and fatigue (4.7% reported using yoga for wellness/prevention and 47.6) Aromatherapy 20. Sociodemographic factors include the baby boomer age group.5) 15.8) Commercial weight loss programs 22.7 (2.7 (0.0001 <.0)* (n=1895.2%).6) Hypnosis 16. Other conditions yoga was used for included anxiety (8. After controlling for sociodemographic factors. 22.7% vs.6 (0.0001 . VOL.5 (0.2) Chiropractic 46.0 (3.2 (3.66 .6) 17.9) 7.3 (3. respectively) and use of commercial weight loss diets (14.0 (3. we found that use of CAM therapies other than yoga was highly associated with yoga use. individuals whose religious preference was reported either as “none” or “other” were more likely to use yoga than individuals reporting a Christian religious preference.6 (2. less than 1% of yoga users reported completely avoiding medical doctors.4) 24.d. If we exclude relaxation techniques from the list of other CAM therapies due to its potential overlap with yoga.6% (absolute n=49) were selected to be in the current yoga user subset and receive further questioning about their yoga practice. yoga users are still more likely than yoga non-users to have used at least one other CAM therapy (88% vs. P<. arthritis (6.7)* % (s.7)* % (s.6 (0.02 .01 . Yoga users reported using each of the CAM therapies listed in Table 3 significantly more frequently than yoga non-users.5) 18.0% of the current yoga user subset using it for this purpose.4 (0.) 55.8 (4.8) 14. whether a financial incentive was needed for participation.2) 28.5 (0.3) 15.7) Self-help groups 28. When we applied the model to current yoga users only.0) 6. chiropractic.1) 31. whether a financial incentive was needed for participation.4% vs.2 (1. higher education.3) 25.9 (3.0 (3.9) 2.9) 21.2 (3.3 (3.0) 5.52 . 32.1 (3.8) 4. and to reflect the age-sex distribution of the US adult population.0001 <. MAR/APR 2004.0001). Characteristics of Yoga Users We asked all yoga users about their perceptions of CAM relative to conventional medicine.0) 3.0002 <.2) 13.8 (0.7 (0.6) 16.9 (0.) 64.7 (0.) Health status Excellent or very good Associated health conditions None Back or neck pain Allergy Lung Arthritis Anxiety Depression Gastrointestinal Other chronic pain Headache Insomnia Heart Diabetes 65.5) 41.01 .7) 6.8 (4. Use of relaxation techniques and acupuncture remained significant for current yoga users.6) Energy healing 25.7 (2. 63.2) 42. depression (6.0001 . There were no statistically significant differences between current yoga users and past yoga users in respect to sociodemographic factors (data not shown). Although 22% believed that CAM therapies are “superior” to conventional therapies. with the exception of prevalence of chronic pain (7. and acupuncture (Table 4). equipment).2) 4.7) Folk remedies 23.0) Relaxation techniques 51.6) 9.01 .8 (4.TABLE 2 Health Status for Yoga Users and Yoga Non-users Yoga Users (n=154.4 (4.1 (4. In addition.8 (0.4 (0. female gender.3) 70.2 (3. number of adults in the household. massage.1 (0.8) 8.6 (3. NO.0 (0.8) 5.5 (1. Of the current yoga users.0001 <. Back or neck pain was the most common health condition treated with yoga with 21.0001 .0 (4.6) 1.004 non-users had used at least one other CAM therapy in their lifetime. Eighty-five percent felt that using both conventional and alternative medical therapies was better than using either one alone.75 *Number of yoga users and yoga non-users are weighted for geographical distribution.03 <.6) P-value TABLE 3 CAM Utilization for Yoga Users and Yoga Non-users Yoga Users Yoga Non-users (n=154.8%).6) 5. 2 47 .5) Acupuncture 12. Lung disease was the only health condi- * Number of yoga users and yoga non-users are weighted for geographical distribution. and living in a metropolitan area.3 (0.01 .7 (4.2) 7.d. homeopathy.6 (1.0001 <.0) 3.5) Imagery 30.2 (4.0001 . tion independently associated with yoga use.1) Yoga Non-users (n=1895. energy healing. respectively).5%.4) 13. 64. 93% of yoga users had used at least one other CAM therapy (P<.9 (4.9) 19.6 (1.0001 .9 (1.04 .1 (0.9 (0.2 (3.6) Lifestyle diets 21.0001).0%.8 (1. 76% did not report spending money in the previous 12 months relating to yoga (eg.0001 . 10.3 (3. Unfortunately.2 (2.d.
education beyond high school.7% did not discuss their yoga use with their doctor.7 in the 1970s.TABLE 4 Multivariable Analysis of Factors associated with Yoga Use Factor Age group 18-33 yrs (post-baby boom) 34-53 yrs (baby boomers) ≥ 54 yrs (pre-baby boom) Sex Female Male Religious preference None Other Christian Education > High school education < High school education Urbanicity Large metro area (>1 million) Small metro area (50.”26 no systematic evaluations of physical and/or mental risks have been reported.13 American adults used yoga in 1998 more frequently than acupuncture. The most common reasons cited for nondisclosure included the doctor never asking (68%) and not believing it was important for the doctor to know (64%). In light of increased media attention to yoga subsequent to the survey.2 (1.5) 1.6. Rates of other CAM use were very high among yoga users.8 in the 1980s.0 2.4-3. yoga was used less frequently than herbs. limiting the sample to English-speaking adults with a telephone.8) 1. Generalizability of the current yoga user subset data (eg. and the low absolute number of yoga users. Due to yoga’s popularity.3 (1. membership in the baby boomer generation. The survey unfortunately did not collect any data on frequency of use. this is the first published report of yoga prevalence and patterns of use in the US using a nationally representative sample.27-28 orbital varices. particularly among women.0 1. different types of yoga practiced. 5. It is used both for wellness and as an adjunctive treatment for common health conditions such as back or neck pain.3 (1. Limitations of this study include the low overall response rate.4) 2. perceived helpfulness. spiritual). chiropractic. 2 Prevalence and Patterns of Adult Yoga Use in the United States .3) 2.1 (1. supplements. use for wellness and health conditions.5 in the 1990s. and those with higher education. Relative to the rate of initiation of yoga use in the 1930s-1950s. homeopathy. In addition.7 (1. Although the frequency of such events is likely rare.19 Many of these trials of yoga (eg. In contrast to other popular CAM therapies such as chiropractic. massage. there are insufficient numbers to make any statement about yoga use in specific racial/ethnic minorities or specific non-Christian religions. often with high degrees of perceived helpfulness.8-7. and lack of expenditure by many of its users.8) 1.0 (1. Female gender.2-2.3 (0. hypnosis. it was rare for the yoga user to feel that the doctor would discourage (3%).7-3. or biofeedback.0-10. the relative rate of starting yoga in the 1960s was 2. there is evidence that yoga use has overall been increasing.21 osteoarthritis. or discontinue care of the user (0%). 2. Based on age of first use of yoga.1-3.3-5. Yoga was not included in Eisenberg’s initial 1990 national CAM survey.7-10. their true incidence cannot be estimated. Yoga is a common practice.16 Interestingly.0 2.2-4.22 depression. NO.13 the majority of yoga users in 1998 did not make any expenditure related to their yoga use. Of the 49 current yoga users. massage.17 so a direct comparison of yoga use rates between 1990 and 1998 unfortunately cannot be made.4 (4.0 5. no judgments can be made from this data regarding the efficacy or safety of yoga. 10. despite yoga’s greater prevalence of use than other well-known CAM therapies such as acupuncture. social.5% of the US adult population or 15 million adults in 1998 had used yoga at least once in their lifetime. we urge well-designed randomized controlled trials incorporating quanti- 48 ALTERNATIVE THERAPIES. and 5.6-5.3-3.7-2. vertebrobasilar artery occlusion. or other possible reasons for yoga use (eg. proportion spending money on yoga) is also limited by the small size of this subset.5) 6. and anxiety.0) 2. asthma.8) 2. depression. or imagery. whereas a similar search for acupuncture yielded 427. and living in a metropolitan area were independent sociodemographic correlates associated with yoga use. and herbs.000 – 1 million) Non metro area (<50. perceived helpfulness. baby boomers.9.0) 1.3 (1. disapprove (3%).4-3.6) 2.5 (1.9) 1.3 (2.7) 1. Conversely.11 our data likely reflect an underestimate of present levels of yoga use. DISCUSSION To the best of our knowledge. Lastly.5) number of yoga users reporting expenditures for yoga (n=10) precludes any meaningful estimates of national spending on yoga. a Medline search from 1975-2002 revealed 43 randomized controlled trials of yoga.8 (1. By contrast.6 (1. Kessler used our 1998 data to estimate long-term trends of yoga use.4-4.000) Children <18 yrs old living in household No Yes CAM use other than yoga Any CAM use Relaxation techniques Homeopathy Energy healing Acupuncture Associated health conditions Lung disease Odds Ratio (95% Confidence Interval) 1. Compared to previously published prevalence data for other CAM therapies derived from our data set.8 (1.1 (1. Respondents who practiced yoga in 1998 used it both for wellness and common health conditions (especially back or neck problems).29 musculoskeletal strains30). There are several reports suggesting that serious adverse events from yoga use are possible (eg. However. Our data estimate that 7. 74. our 1998 data may not reflect current levels and patterns of yoga use.4-5.0 3. there is a disproportionately smaller Western scientific literature on yoga.0 3. Although yoga is considered “largely safe. For example. VOL. urban dwellers.20 carpal tunnel syndrome.4) 2.9) 2. Approximately half of these people used yoga in 1998. MAR/APR 2004. For example.23 coronary artery disease24-25) are unfortunately limited in their sample size and generalizability.2-7.
2000.135:262-68. 2. MI. 1999. Boston. Ports TA. J Affect Disord. Singhal A. Ann Arbor. Ettner SL. Chang CM. The New York Times.gov/briefing/rurality/ruralurbcon. Vedanthan PK. Fitness programs trends report. 2001 Apr 23. JAMA. Scherwitz LW. for programming assistance. Kesavalu LN. philosophy. The San Francisco Chronicle. Berkeley. The New York Times.fcgi. Yu YL.Sect. Norman D. Allergy Asthma Proc1998. 1990. Prescott. Schatz MP. AZ: Hohm Press. Norlock FE. Stretching has its limits: injuries are on the rise as newcomers take up yoga. 1998. 1977. 2002. E:1. Billings JH. costs. Version 7. Stretch & deliver: more women are turning to pre. Dr Phillips is supported by a Mid-Career Investigator Award (K24 AT00589-02) from the National Center for Complementary and Alternative Medicine.ncbi. A:1. Lai CW. Harish MG. Dr Saper is supported by an Institutional National Research Service Award for training in Alternative Medicine Research (T32 AT00051). Billings JH.and post-natal yoga to cope with pregnancy and new motherhood.txt. Garfinkel MS.usda. Williams L. 3. 2001. Homer TD. J Rheumatol. Subbakrishna DK. Brown SE. 27. Dembner A. Hanus SH. US Bureau of the Census. Pittler M. 8. Research Triangle Park. Fetzer Institute. 23. for their assistance with telephone data collection. American influences help redefine practice of yoga. 13. Long-term trends in the use of complementary and alternative medical therapies in the United States. 2002 Dec 29. 28.34:574-75. 2003. Levy M. Stewart M. The Stage. Duvall K. Ernst E. Yoga trumps bingo as centers for aged try new approach. 1997. Ann Intern Med. 5. Schumacher HR.census. Eisenberg DM. for editorial suggestions. Phillips K. 1994.73. 1998. Van Rompay MI. 2002 Jan 13. The original survey was supported in part by National Institutes of Health grant U24 AR43441. The New York Times. 26. Evaluation of a yoga based regimen for treatment of osteoarthritis of the hands. SUDAAN: Professional Software for Survey Data Analysis [computer program]. Peter Wolsko. Scherwitz LW. 21. 19:47-52. Cheung RT.Sect. Char DH.19:3-9. Reshetar RA. Janakiramaiah N. Naga Venkatesha Murthy PJ. 12. Antidepressant efficacy of Sudarshan Kriya Yoga (SKY) in melancholia: a randomized comparison with electroconvulsive therapy (ECT) and imipramine. 19. MD. and Z. Edinburgh: Mosby. Appel S. 15. 2002 Mar 10. National Institutes of Health. Unconventional medicine in the United States: prevalence. 280:2001-7. Taking a big breath. MD. Yoga abound in type-A county. Lancet. Bilateral orbital varices associated with habitual bending. Wilkey S. The Boston Globe. Schumacher HR. 21:2341-43. Ulick J.336:129-33. MA. 1993. Yoga for children. Bethesda. Katz WA. Cohen JA. 7. Foster C. Yoga-based intervention for carpal tunnel syndrome. 20. 1990-1997: results of a follow-up national survey.gov/entrez/query. PhD. 24. Merritt TA. Can lifestyle changes reverse coronary heart disease?: the lifestyle heart trial. Husain A. Ornish D. Yoga: believe the hype. Butler Foundation. 57:255-59. Sonin E. safety. Hall MJ. the Friends of Beth Israel Deaconess Medical Center. Calkins DR. Ornish D. 8:9. 29.B. 14. Newsweek. NC: Research Triangle Institute. 2001 Apr 12. Germeshausen Foundation.5. et al. 2001 Jun. The New York Times. 11. Gangadhar BN. NFL tackles yoga. White A. 2002 Dec 2.E. IL. accessed on October 10. the John E. Resident Population Estimates of the United States by Age and Sex: April 1. Vertebral artery occlusion complicating yoga exercises. 22. Davis RB. and practice. 17. literature. Davis RB. Foster DF. Delbanco TL. 9. 2003 Jan 8. 4. Torassa A. 1992. et al. et al. Stevinson C. 1998. Lousada S. National Institutes of Health. Harter DH.tative and qualitative measures to evaluate its objective and subjective effects.30:104-9. CA: Rodmell Press. Kalamazoo. 18. Clinical study of yoga techniques in university students with asthma: a controlled study. Allan DA. Reshetar R. The power of yoga. Arch Opthalmol. 2001 Jun 3. The desktop guide to complementary and alternative medicine: an evidence-based approach. 10. Vedamurthachar A. 2000 Aug 1. 1990 to July 1. 2002. References 1. Schaumburg. 25. Available at www. Acknowledgments The authors thank the staff of DataStat. the American Society of Actuaries. 1995. Feuerstein G. the Kenneth J. Armstrong WT.nih. Powers A. 30. Inc.28. Van Rompay MI. 14WC:2. Kessler RC.Sect. Available at www. accessed on March 30. p 78. available at http://eire. 280:1601-3. NY. and patterns of use. JAMA.113:1360-2. et al. and the J. eds. 280:1569-75. 16. New York. Eisenberg DM. IDEA Health & Fitness Source. et al. Kessler RC. 1993. Rosenberg M. Flex appeal. Intensive lifestyle changes for reversal of coronary heart disease.gov/popest/archives/ national/ nation2/intfile2-1.ers. Time. Basilar artery occlusion following yoga exercise: a case report. Murthy KC. New York: Fireside. MI.58-63. Gould KL. JAMA. Funderburg L. . N Engl J Med. Garfinkel MS. Sect. Wilkey SA. and cost-effectiveness. Fong KY. and Sat Bir Khalsa.328:246-52. accessed on April 18. 1998. Arch Neurol. Baker S. Sect. Sect. F:7. Walters EE. The yoga tradition: its history. 6. 1993. Trends in alternative medicine use in the United States. Brown SE. 2001. Clin Exp Neurol. Back care basics: a doctor’s gentle yoga program for back and neck pain relief. Kleinfeld N. A:1.
Boulder. MAR/APR 2004. PhD. Warren. the data were divided into better or not categories. Richard Stockton College of New Jersey and NIH-NCCAM Fellow.brief report THE IMPACT OF MODIFIED HATHA YOGA ON CHRONIC LOW Bzdewka. Chronic pain presents with many facets. analysis of the qualitative data revealed the following frequency of responses (1) group intervention motivated the participants and (2) yoga fostered relaxation and new awareness/learning. twice a week for 6 weeks. Jamie L. Eissler-Russo. Methods • A specific CLBP yoga protocol designed and modified for this population by a certified yoga instructor was administered for one hour. This pilot study supports the need for more research investigating the effect of yoga for this population. MPT. MSCE is adjunct assistant professor of epidemiology and anesthesiology. Low back pain is the most prevalent of musculoskeletal conditions. PT.3 Multidimensional approaches that incorporate the dimensions of physical. it affects nearly everyone at some point in time and about 4-33% of the population at any given point. NJ. Paula Geigle. Jamie L.2 Cultural factors greatly influence the prevalence and prognosis of low back pain.10(2):56-59. . University of Pennsylvania. MD. University of Pennsylvania. 2995 Wilderness Place. by endorsing the Bone and Joint Decade 2000-2010. Farrar. Eissler-Russo.5 Yoga is one of these treatments. 2 Hatha Yoga and Chronic Low Back Pain . and social care systems. Cape May Courthouse. are now generally accepted as better determinants of the individual’s experience with pain. Purpose • The purpose of this randomized pilot study was to evaluate a possible design for a 6-week modified hatha yoga protocol to study the effects on participants with chronic low back pain.1 The United Nations and World Health Organization have recognized this burden. Qualitative data were analyzed through frequency of positive responses. 2004. PhD.4. e-mail. Bzdewka MPT. and social function. and analyzed using chi-square to examine differences between the groups. is a NIHNCCAM Fellow. Primary functional outcome measures included the forward reach (FR) and sit and reach (SR) tests. is affiliated with the Bacharach Institute for Rehabilitation/Atlantic City Medical Center. .3 While there are many potential therapies for back pain. (Altern Ther Health Med.com. is affiliated with Cape Atlantic Physical Therapy Clinic. MPT. John T. PT. health systems. Todd M. Results • Potentially important trends in the functional measurement scores showed improved balance and flexibility and decreased disability and depression for the yoga group but this pilot was not Reprint requests: InnoVision Health Media. MD. Holbrook. phone. Yoga is currently enjoying increased interest M 56 ALTERNATIVE THERAPIES. between the ages of 30 and 65. (303) 440-7402. Chronic pain customarily is pain that persists for more than 3 to 6 months or beyond the expected period of healing.STUDY BACK PAIN: A . VOL. In addition. with chronic low back pain (CLBP) were randomized to either an immediate yoga based intervention. All participants completed Oswestry Disability Index (ODI) and Beck Depression Inventory (BDI) questionnaires. group dynamics. Mary Lou Galantino. once the pain becomes chronic. the impact on depression and disability could be considered as important outcomes for further study. with indirect costs being predominant. Matthew L. . Todd M. Analysis • To account for drop outs. PhD MPT MPT MPT Eric P. Mogck MPT. Paula Geigle PT. Additional functional outcome measures should be explored. CO 80301. alternative-therapies@innerdoorway. Farrar.3 Interventions that treat more than one aspect of chronic low back pain (CLBP) are an important group to investigate. F=17). powered to reach statistical significance. (303) 440-7446. NJ Eric P. psychological. Also. but a larger study is necessary to provide definitive evidence. Guiding questions were used for qualitative data analysis to ascertain how yoga participants perceived the instructor. 10. Conclusion • A modified yoga-based intervention may benefit individuals with CLB.) usculoskeletal conditions are a major burden on individuals. Mogck. MSCE Mary Lou Galantino PT. and John T. is a graduate of Richard Stockton College of NJ. Back injuries are the leading cause of disability in the United States for people younger than 45 years and the most expensive healthcare problem for the 3050-year-old age group. NO. University of Pennsylvania.PILOTL. or to a control group with no treatment during the observation period but received later yoga training. Recent research suggests a need for a more active approach transitioning from passive longterm rest toward progressive activity and exercise. Significant limitations included a high dropout rate in the control group and large baseline differences in the secondary measures. and the impact of yoga on their life. fax. and does not fit a simple model. is affiliated with Complete Health Fitness. MPT. Suite 205. is a professor at the Program in Physical Therapy. PhD. Participants • Twenty-two participants (M=4. currently there are few treatments with clearly demonstrated efficacy. Matthew Holbrook.
F=17).as a potential treatment for musculoskeletal disorders. and qualitative measurement. and meditation is intended to challenge muscle strength. to date. To encourage ongoing participation of the subjects in the control group. Participants were asked to complete the 1 hour a day session as frequently as possible throughout the week with comfort level guiding their participation. cat. and through healthcare practitioners. Participants focus on the feedback from the stretch sensors in the muscles. Beck Depression Inventory (BDI). After signing consent.18. Sit and Reach Test (SR) and Functional Reach Test (FR) measured at baseline and end of the study in both groups. NO. half spinal twist l Sun Salutation l Relaxation and Meditation *modifications of various postures based on participant abilities/tolerance Hatha Yoga and Chronic Low Back Pain ALTERNATIVE THERAPIES. between the ages of 30 and 65. VOL. Exclusion criteria included subjects with (1) previous yoga experience. Yoga postures were demonstrated and adapted to the capabilities of each individual to prevent injury. Two areas demonstrating evidence of methodological thoroughness are the use of nonsteroidal antiinflammatory drugs and muscle relaxants. (2) a current history of a chronic systemic disease (eg. and also return for re-evaluation. kneeling postures l Backward bending: cobra l Forward bending: preparation head-to-knee. A single instructor. joint flexibility and balance. Feedback was provided to the subjects to assist them in comfortably achieving and maintaining positions with proper body mechanics and proper breathing technique. especially the lack of control group. studies on yoga do not employ optimal scientific methodology. standing horizontal. and joints to prevent reflex contraction and enhance stretching. These journals included a series of four qualitative questions that had been developed by a panel of experts in yoga. ligaments. MAR/APR 2004.9. who was certified by the Yoga Alliance directed each one hour hatha yoga session. a systematic review of back pain studies 7. Measurement tools Measurement tools included Oswestry Disability Index (ODI). Yoga Intervention Hatha yoga was selected for its gentle style. Postures were selected based on orthopedic biomechanics (Table 1). 12 Progression through a sequence of postures.15 One study reports changes in pituitaryadrenal activity. Subjects were requested to report any medication change during the study period. including a classic period of meditation and relaxation at the beginning and end.10 There are few studies of non-traditional interventions such as tai chi. the yoga group was given a journal to be filled out after each yoga session to assess their perception of the yoga experience and evaluate the extent of their participation in the yoga training. with CLBP enrolled in this study. overhead. Only one study by Wolf and colleagues examined tai chi as an exercise for improving balance in the elderly. corpse. Inclusion criteria consisted of: (1) subjects who experienced pain for more than 6 months and (2) had undergone more than 2 conservative medical interventions (physical therapy and chiropractic) previously without prolonged relief. and yoga.11 but no specific published study investigates non-traditional intervention for the person living with CLBP. triangle l Preparation hand-to-foot: hand to foot posture l Sitting: easy. 10. and yoga day frequency during the study. METHODS Subjects After Investigational Review Board approval. knees to chest pose l Stretching postures Symmetrical. members of the control group were instructed to continue with their usual daily activities. Subjects were assigned to the yoga or control group using sequential random numbers. 2 57 . Most were self referred through a local newspaper advertisement. simple back Asanas/preparatory exercises: Standing: tree. and for its availability to the public.19 In addition. An expert panel of two hatha yoga instructors with greater than 10 years of experience and a physical therapist specializing in spine treatment established an initial yoga protocol for this study. The participants’ condition was verified by a physical exam. diabetes or cancer) and (3) changes in medication specifically for the pain process in the last 14 days or during the study. 22 subjects (M=5.14.8 revealed few therapeutic trials exhibiting rigorous methodological quality. base line data was collected. head to knee l Twisting: twisting. With no published studies investigating the specific effect of yoga on CLBP. a similar course of yoga therapy was made available to this group after the completion of the study period. this mechanical musculoskeletal stimulation is thought to be responsible for the benefits of yoga. The yoga group met 2 times per week for a 6-week period for a formal session. side. Over the same 6-week period. which report positive outcomes for acute low back pain. A history of surgery was not an exclusion criterion.13 When combined with meditation. Specifically: 1) What is the best part of this experience for you? What do you look forward to most about yoga? 2) What is diffiTABLE 1 Yoga Postures Introduction to yamas and niyamas Diaphragmatic breathing/relaxation postures: l Simple standing.17. our study was planned as a pilot to gather the data necessary to implement a definitive study of an adapted yoga protocol for individuals with low back pain. and current medication use was recorded. Yoga The practice of yoga focuses on the control of voluntary nervous system and muscle functions using a sequence of postures that leads to a state of relaxation. 16 However. posterior stretch.6 While many studies exist on the effectiveness of interventions for the treatment of CLBP. Yoga participants did not record how many minutes per day.
Assuming that the 3 lost to follow-up were failures. Secondary functional measures of the functional reach and sit reach improved in 64% and 90% respectively of the experimental group. Chi square inferential statistics were calculated.10 13.91 17. 2 Hatha Yoga and Chronic Low Back Pain .534). ANALYSIS Descriptive statistics include percent means and standard deviations of each group. MAR/APR 2004. suggesting that they were less depressed after 6 weeks. NO. the three-month evaluation showed a potential for improvement in disability. Eight of 11 patient responses were received from the 3-month follow-up survey.96 2.36 9. Despite reported benefit of yoga.15 10. the yoga journal and followup questions about the yoga experience were analyzed as qualitative data grouping the answers into positive and negative categories.50 10.55 8. The sample size of this pilot study was not intended for an efficacy analysis but rather to obtain an estimate of the effect size and variance necessary to plan a definitive study. and 3) would they recommend yoga for treatment of CLBP to others (yes or no). RESULTS Twenty-two subjects were enrolled in the study.07. collected only in the yoga group.27 7. Such differences are less likely in a larger study and should be included to ensure similarity at baseline and to document any changes over time. For the yoga group. while avoiding the use of the last observation carried forward.338).18 BDIpre 15.43 3.90 FRpre 10. However. The frequency of positive responses by the subjects were counted and recorded. did not improve. all respondents were not currently participating in yoga classes. It consisted of 4 questions: 1) Was their CLBP better the same or worse than before yoga. Also.45 5.91 5.18 6.81 FRpost 9. DISCUSSION This pilot was conducted to evaluate issues that will be important in the design of a study to examine the effect of yoga on flexibility. 6 (54%). Fifty-four percent of the subjects in the experi- mental group while only 20% of the control group had lower scores on the BDI. The large differences in depression scores between the groups at baseline prevent any conclusion from this data. In a before-after comparison. the data suggest that balance and flexibility may improve through the use of yoga intervention for CLBP. to test and refine individual components of the yoga protocol and measurement tools. Analysis of the qualitative weekly journals.79 7. Assuming those who did not return.56 21. but that there may be only a slight improvement in disability.386.67 12. 10. P=0.008). balance and quality of life on a CLBP population.170). 2) had they continued to practice yoga at least once a week (yes or no). 40% of the control and 46% of the experimental groups reported themselves as less disabled on the ODI. reported improved low back pain since completion of the study. VOL. all participants did not continue.91 4.49 24.95 SRpre 10.20 BDIpost 17.99 58 ALTERNATIVE THERAPIES. and there are no statistical significant differences between groups. while only 2 (20%) subjects of the control group improved.28 1. 7 (63%) stated that benefits from yoga were still present. Six subjects from the control group did not return to complete the second set of questionnaires and are treated as failures in the ITT analysis Means and standard deviations are noted in Table 2. To account for differences in baseline values. and to obtain pilot data on the magnitude and variability of the response.30 SRpost 10. FR (chi-square=0.87.97 2.917. with 11 subjects randomized to each group.98 10. revealed the following frequency of responses (1) 10 of the 11 (90%) subjects in the experimental arm of the study felt that group intervention motivated them and (2) All subjects indicated that yoga fostered relaxation and new awareness/learning. P=0. Dichotimization allowed an intent to treat analysis (ITT).05 5. results are presented as percent change from baseline. P=0. Other Chi-square analysis provided the following results: ODI (chi-square=1. except for the BDI which was substantially higher in the control group (chi-square=7. but a longer evaluation would be needed as disability report may vary over time. What makes the group experience different from exercising independently? A 3-month follow-up survey was sent to all subjects who completed the yoga group training. However.73 18. P=0.91 3. SR (chi-square=0.12 16. these results suggest. a possible role for yoga in improving functional measures. and determining the frequency of a positive response to better understand how to design a larger study.cult about being involved with the group? What are you most frustrated with? 3) What is the impact of the yoga instructor on this experience for you? 4) Imagine yourself performing yoga alone. For each measure any level of improvement was considered positive and stable or decline as negative. BDI. Future studies should investi- TABLE 2 Means and Standard Deviations Group Control Mean Standard Deviation Yoga Mean Standard Deviation ODI—Oswestry Disability Index BDI—Beck Depression Inventory FR—Forward Reach SR—Sit and Reach ODI-pre 36.28 ODI post 38. 8 (72%) recommended yoga to other clients with CLBP. along with depression.
Given the emphasis of yoga on stretch and balance. Bohle MV: Some physiological considerations about asanas. How many days of bed rest for acute low back pain? A randomized clinical trial. Potential participants respond to engage in the advertised clinical intervention. Lippincott Williams & Wilkins. Back Pain: New Approaches to Rehabilitation and Education. J Altern Complement Med. AHCPR publication. Exploring the basis for Tai Chi Chuan as a therapeutic exercise approach. our study found functional changes and improvement in quality of life that should encourage further comprehensive and carefully designed studies. MAR/APR 2004. Physiother Can. A comparison of five low back disability questionnaires: reliability and responsiveness. 25: 2688-2699. Raju PS. 4. 2003. 1997. Burden of major musculoskeletal conditions. Beck Depression Inventory Manual. 8. and a comparison with St. and validity. New York: Harcourt Brace. Jenner. Arch Phys Med Rehabilitation. Bull World Health Organ. Group intervention provides a socialization context for support and may offer a potential cost effective way to manage CLBP. Van Tulder MW.17 However. In Loeser JD (ed. 39: 96-101.gate what parameters contributed to yoga non participation after study termination. 15. Rockville. et al. The impact on depression and disability is a primary outcome for further study. Nespor K. it is important to identify and include assessment tools that capture the translation of improved balance and flexibility through functional assessments at home and return to work. 2002.186. people who are able to do yoga may improve. 1993. 1997. 18. Hatha Yoga and Chronic Low Back Pain ALTERNATIVE THERAPIES. Jacobson L. 4:6-15. Bower O. Madhavi S. Coogler C. Thomas’s Disability Index. Steer RA. A yoga health model includes all dimensions of the individual’s body. Osteo R. 4: 122-126. 1997. In Galantino ML (ed) Orthopaedic Physical Therapy Clinics of North America. Philadelphia. NO. Taylor W. Diehl AK. education. Group intervention provides a socialization context for support and may offer a potential cost effective method to manage CLBP. Evans C. AD. 36: 72-28. Yoga. Spine. 5. Epub 2003 Nov 14.81(9):646-56.10: 54-60. 1991. However it is unknown whether understanding yoga benefits translates into long term participation since participants did not pursue yoga activities beyond the study. 1987. mind and spirit that may well affect the human experience of pain. This pilot study supports the need for further research in the effect of yoga for individuals with CLBP. when adapted for the individual with CLBP may complement traditional physical therapy interventions. Matthew J. The impact on depression and disability indicate that measures of this phenomenon should be included in any future study. The lack of studies on yoga prompted us to present this preliminary data to encourage further clinical studies of this modality and present issues about the study design. 7. Future researchers might consider additional clinical arms that include physical therapy and other types of movement therapy. Rosenthal M. Int J Psychosom. 12. et al. Spine. Pfleger B. References 1. Marino AJ. 3. as well as expanded functional outcome measures. 2001. General Considerations of Chronic Pain. 3: 291-295. 1997. Woolf. Jevning R. Incorporating yoga therapeutics into orthopaedic physical therapy. ACP Journal Club. Bouter LM. Koes. manipulation. repeatability. CONCLUSION This pilot study sets the stage for a randomized controlled trial study to examine the potential short and long-term effects of yoga which may prove beneficial in the management of CLBP. Srinivasan TM. Given the participants’ report of less depression. Xu T. Md: Agency for Health Care Policy and Research. Beck AT. 1978. we also recommend inclusion of an appropriate measurement of the yoga psychological aspect. 82: 8-24. 11. 2000. 19. and exercise reduce chronic low back pain. Braen G. Adrenocortical activity during meditation. 2. N Engl J Med. Bart W. 20. back schools. Although not powered for statistical significance. Acute low back problems in adults. 315: 1064-1070. the use of the ODI provides a reliable measure of perceived disability for CLBP. Morley SJ. Taylor. Gilbert JR. Current Review of Pain. Assendelft WJ. 2000: 341-352. For back pain. Third Edition. and bed rest for participants with acute low back pain. 1994. Influence of Intensive Yoga Training on Physiological Changes in 6 Adult Women: A Case Report. as well as expanded functional outcome measures. 1989: 174. 2 59 . 22: 2128-56. Asana-based exercises for the management of low back pain. The forward reach (FR) and sit and reach (SR) provide a measurement of flexibility and balance at one point in time. and Davidson JM. 56: 214-223. 14: 95-0642. 10. et al. A randomized controlled trial of flexion exercises. The Psychological Assessment of Patients with Chronic Pain. not to continue without the intervention. Ananthanarayanan TV. Journal of International Association of Yoga Therapists. 9. 15:13-30. 16. Review: NSAIDS and muscle relaxants reduce acute low back pain. Psychosomatics of back pain and the use of yoga. Davidson M. Keating J. Linton SJ. Another limitation is that any of a number of the activities related to a group interaction. 10. Horm Behav. Lebovits AH. 87: 886-92.) Bonica’s Management of Pain. Van Tulder MW. Majundmar. Bigos S. 2000.20 The qualitative data in this study support the potential benefits of yoga were understood. 17. Efficacy of non-steroidal anti-inflammatory drugs for low back pain: a systematic review of randomized clinical trials. 13.1969. such as occurs in a yoga class. Wilson AF. VOL. Hildebrand A. 1986. 14. Prasad KV. Clinical Practice Guideline. Deyo RA. Behavioral treatment for chronic low back pain: A systematic review within the framework of the Cochrane Back Review Group. Since CLBP involves all these factors. 6. Conservative treatment of acute and chronic nonspecific low back pain: A systematic review of randomized controlled trials of the most common intervention. Koes BW. may have played a role in the overall improvement of the subjects through non-specific effects (the control group did not meet in any group activity). EBM Reviews-ACP Journal Club. 1998. People with chronic diseases often explore alternative movement therapies to deal with their unresolved pain. Yoga Mimamsa. Ann Rheum Dis. A major issue was the difficulty in maintaining an appropriate control group for this clinical intervention study.18. we advise the addition of specific pain and discomfort scales such as the Brief Pain Inventory with a pain interference scale. Vlaeyen JW. Physical Therapy. 128: 65. The Oswestry Disability Index revisited: its reliability. 1994. Roland M. Wolf SL.
This action might not be possible to undo. Are you sure you want to continue?
We've moved you to where you read on your other device.
Get the full title to continue reading from where you left off, or restart the preview.