Background: Hernia is an abnormal protrusion of an organ or tissue through a defect in its surrounding walls which most commonly involves the abdominal wall, particularly the inguinal region. The treatment options for hernia ranges from simple exercises to modern surgeries. The effect of yoga therapy is not scientifically examined for reversible inguinal hernia and hence this study is undertaken with the aim to test the effect of selected asanas in reversible inguinal hernia. Materials and Methods: A quasi experimental trail of 19 males through consecutive sampling was done with selected asanas for three months and the outcome was measured by a questionnaire focusing on pain, aggravating factors, relieving factors and frequency of occurrence of symptoms of hernia. Results: The pre and post interventional data were compared statistically and found significant reduction of symptoms with P≤0.001 in pain, frequency of occurrence and aggravating factors. The relieving factors showed significant increase with P≤0.001. Conclusion: Yoga therapy with selected asanas is effective in the treatment of reversible inguinal hernia.

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Objectives: The aim of this study is to evaluate the efficacy and tolerability of Sudarshan Kriya Yoga (SKY) course in generalized anxiety disorder (GAD) outpatients, who after eight weeks of an appropriate dose of traditional therapy had not yet achieved remission. Subjects: The adult participants (18-65 years) were outpatients with a primary diagnosis of GAD with or without comorbidities on the Mini-International Neuropsychiatric Interview (MINI). Participants had a minimum of eight weeks standard treatment with an appropriate dose of a standard prescription anxiolytic, a clinician global impression-severity (CGI-S) score of 5-7, a Hamilton anxiety scale (HAM-A) total score ≥20 including a score of >2 on the anxious mood and tension items. Materials and Methods: Forty-one patients were enrolled in an open-label trial of the SKY course as an adjunct to standard treatment of GAD at the START Clinic for Mood and Anxiety Disorders, a tertiary care mood and anxiety disorder clinic in Toronto. The SKY course was administered over five days (22 h total). Subjects were encouraged to practice the yoga breathing techniques at home for 20 min per day after the course and were offered group practice sessions for 2 h once a week led by certified yoga instructors. The primary outcome measure was the mean change from pre-treatment on the HAM-A scale. Psychological measures were obtained at baseline and four weeks after completing the intervention. Results:Thirty-one patients completed the program (mean age 42.6 ± 13.3 years). Among completers, significant reductions occurred in the pre- and post-intervention mean HAM-A total score (t=4.59; P<0.01) and psychic subscale (t=5.00; P≤0.01). The response rate was 73% and the remission rate 41% as measured on the HAM-A. Conclusion: The results of this small pilot trial suggest that the SKY course represents a potentially valuable adjunct to standard pharmacotherapy in patients with GAD or treatment-resistant GAD, and warrants further investigation. In particular, changes in worry and body symptoms showed significant improvements that may further our understanding of the mechanism of change in the tolerance of anxiety and worry.

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Aim: To study the effect of integrated yoga on pain, morning stiffness and anxiety in osteoarthritis of knees. Materials and Methods: Two hundred and fifty participants with OA knees (35-80 years) were randomly assigned to yoga or control group. Both groups had transcutaneous electrical stimulation and ultrasound treatment followed by intervention (40 min) for two weeks with follow up for three months. The integrated yoga consisted of yogic loosening and strengthening practices, asanas, relaxation, pranayama and meditation. The control group had physiotherapy exercises. Assessments were done on 15 ^th (post 1) and 90 ^th day (post 2). Results: Resting pain (numerical rating scale) reduced better (P<0.001, Mann-Whitney U test) in yoga group (post 1=33.6% and post 2=71.8%) than control group (post 1=13.4% and post 2=37.5%). Morning stiffness decreased more (P<0.001) in yoga (post 1=68.6% and post 2=98.1%) than control group (post 1=38.6% and post 2=71.6%). State anxiety (STAI-1) reduced (P<0.001) by 35.5% (post 1) and 58.4% (post 2) in the yoga group and 15.6% (post 1) and 38.8% (post 2) in the control group; trait anxiety (STAI 2) reduced (P<0.001) better (post 1=34.6% and post 2=57.10%) in yoga than control group (post 1=14.12% and post 2=34.73%). Systolic blood pressure reduced (P<0.001) better in yoga group (post 1=−7.93% and post 2=−15.7%) than the control group (post 1=−1.8% and post 2=−3.8%). Diastolic blood pressure reduced (P<0.001) better in yoga group (post 1=−7.6% and post 2=−16.4%) than the control group (post 1=−2.1% and post 2=−5.0%). Pulse rate reduced (P<0.001) better in yoga group (post 1=−8.41% and post 2=−12.4%) than the control group (post 1=−5.1% and post 2=−7.1%). Conclusion: Integrated approach of yoga therapy is better than physiotherapy exercises as an adjunct to transcutaneous electrical stimulation and ultrasound treatment in reducing pain, morning stiffness, state and trait anxiety, blood pressure and pulse rate in patients with OA knees.

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Background: Yogic practices may aid in the prevention and management of diabetes mellitus (DM) and reduce cardiovascular complications in the population. The present study has been undertaken to evaluate the effect of yoga therapy on reaction time, biochemical parameters and wellness score of peri and post-menopausal diabetic patients. Materials and Methods: 15 peri and post-menopausal patients receiving standard medical treatment for type 2 DM were recruited and reaction time and biochemical investigations were done before and after a comprehensive yoga therapy program comprising of three times a week sessions for six weeks. A post-intervention, retrospective wellness questionnaire compiled by ACYTER was used to evaluate the comparative feelings of the patients after the therapy program. Results: Yoga training reduced auditory reaction time (ART) from right as well as left hand, the decrease being statistically significant (P<0.05) for ART from the right hand. There was a significant (P<0.01) decrease in fasting and postprandial blood glucose levels as well as low density lipoprotein. The decrease in total cholesterol, triglycerides, and very low density lipoprotein and increase in high density lipoprotein was also statistically significant (P<0.05). All the lipid ratios showed desirable improvement with a decrease (P<0.01) of TC/HDL and LDL/HDL ratios and increase (P<0.05) in the HDL/LDL ratio. Discussion : Shortening of RT implies an improvement in the information processing and reflexes and is the first such report in diabetic patients. This has clinical significance and is worth further exploration with wider, well controlled, randomized studies in the diabetic population. Changes in blood glucose levels may be due to improved insulin sensitivity, decline in insulin resistance and increased sensitivity of the pancreatic b cells to glucose signals. Yoga improved the 'heart friendly' status of lipid profile in our subjects and as our participants were peri and post-menopausal, the decrease in cardiovascular risk profile is of greater significance. A comprehensive yoga therapy program has the potential to enhance the beneficial effects of standard medical management of diabetes mellitus and can be used as an effective complementary or integrative therapy program.

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Context: Despite the known health benefits of physical activity, participation rates in cancer survivor groups remain low. Researchers have attempted to identify alternative modes of nontraditional physical activities that may increase participation and adherence rates. This study investigated the determinants of yoga in breast cancer survivors. Aim: To examine predictors of Iyengar yoga adherence in breast cancer survivors using the theory of planned behaviour. Settings and Design: Classes were held either in Campus Recreation facilities or at the Behavioral Medicine Fitness Center at the University of Alberta in Edmonton, Canada. The study was an evaluation of an existing yoga program. Materials and Methods: Twenty-three post adjuvant therapy breast cancer survivors participating in a community-based, twice weekly, 12 week Iyengar yoga program were asked to complete baseline measures of the theory of planned behavior, demographic, medical, health/fitness, and psychosocial variables. Adherence was measured by objective attendance to the classes. Statistical Analysis: We analyzed univariate associations between predictors and yoga adherence with independent t-tests. Results: Adherence to the Iyengar yoga program was 63.9% and was predicted by stronger intention (P<0.001), greater self-efficacy (P=0.003), more positive instrumental attitude (P=0.025), higher disease stage (P=0.018), yoga experience in the past year, (P=0.044), diagnosis of a second cancer (P=0.008), lower fatigue (P=0.037), and greater happiness (P=0.023). Conclusions: Adherence to Iyengar yoga in breast cancer survivors was strongly related to motivational variables from the theory of planned behaviour. Researchers attempting to improve yoga adherence in breast cancer survivors may benefit from targeting the key constructs in the theory of planned behaviour.

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Background: Yoga is a science practiced in India over thousands of years. It produces constituent physiological changes and has sound scientific basis. Aim: Since exam stress modifies lipid profile and hematological parameters, we conducted an investigation on the effect of sudarshan kriya (SK and P) program on these parameters. Materials and Methods: Blood samples of 43 engineering students were collected at four intervals namely baseline (BL), exam stress (ES), three and six weeks practice of SK and P during exam stress. Lipid profile and hematological parameters were measured at all four intervals. Results: ES elevated total cholesterol (TC), triglycerides (TGL) and very low density lipoprotein (VLDL) levels. Hematological parameters affected by ES included neutrophil, lymphocytes, platelet count, packed cell volume (PCV) and mean cell volume (MCV). Three and six weeks practice of SK and P reduced the elevated lipid profile, hematological parameters and improved lymphocyte levels. Conclusion: Our study indicates that SK and P practice has the potential to overcome ES by improving lipid profile and hematological parameters.

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Background: Emotional insecurity, stress, depressive or/and anxiety symptoms are common with variable severity among patients with menstrual disorder. Yogic relaxation therapy (Yoga Nidra) leads to conscious and subconscious recognition of these underlying psychological factors and helps releasing of suppressed conflicts. Objective: To evaluate the effect of Yoga Nidra on anxiety and depressive symptoms in patients with menstrual disorders. Materials and Methods: Subjects were recruited from the Department of Obstetrics and Gynecology, C.S.M. Medical University (erstwhile KGMU), Lucknow Uttar Pradesh, India. The subjects were randomly divided in to two groups: Intervention group (with yogic intervention) and control group (without yogic intervention). Assessments of all subjects were carried out by administering Hamilton anxiety scale (HAM-A) and Hamilton rating scale for depression (HAM-D) at baseline and after six months. Results: The mean age with S.D of the intervention group was 27.67 ± 7.85 years, and for control group was 26.58 ± 6.87 years (among completed intervention group nn = 65 and control group nn = 61). There was significant reduction of scores in HAM-A (P<0.003) and HAM-D (P<0.02) respectively in subjects with mild to moderate anxiety and depressive symptoms after six months of yoga therapy (Yoga Nidra) in intervention group in comparison to control group. Conclusion: The patients with mild to moderate anxiety and depressive symptoms improve significantly with 'Yoga Nidra' intervention. There is no significant improvement in the patients with severe anxiety and depressive symptoms.

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Background: Long-term alternate nostril breathing (ANB) has been shown to enhance autonomic control of the heart by increasing parasympathetic modulation. However, there is no information on the immediate effects of ANB on autonomic control compared to paced breathing (PB) at the same rate in individuals who are inexperienced with yogic breathing. Aim: To examine cardiac autonomic modulation following ANB in comparison to that following PB in individuals who were inexperienced in ANB. Materials and Methods: Twenty healthy individuals (22.3 ± 2.9 years) with no prior experience with ANB engaged in 30 min of both ANB and PB which were preceded and followed by 5 min of normal breathing (PRE, post-ANB, and post-PB, respectively). Mean arterial pressure (MAP) and heart rate variability (HRV) were assessed during all conditions. HRV was reported as spectral power in the total (lnTP), low-(lnLF), and high-frequency (lnHF) ranges and were natural log (ln) transformed. Results: Analysis of covariance revealed lnTP, lnLF and lnHF were greater during both post-ANB and post-PB compared to PRE (P<0.05). MAP and lnLF/lnHF did not significantly differ between conditions. Conclusions: These data suggest that there was an immediate increase in cardiac autonomic modulation following ANB and PB without a shift in autonomic balance in individuals inexperienced with yogic breathing. To our knowledge, this is the first investigation to investigate the autonomic effects of ANB in this population and also to compare the effects of ANB and PB at the same respiratory rate.

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Context: The dental students experience a lot of stress, which increase when they perform their first surgical procedure. Yoga as an anxiolytic tool in anxiety reduction has been practiced over centuries in India. Aim: To assess the efficacy of yoga in reducing the state trait anxiety of dental students before their first periodontal surgery performance. Settings and Design: A randomized controlled study using a two-way split plot design (pre-post-test) was conducted in the department of periodontics, Pacific Dental College, Udaipur, India. Materials and Methods: One hundred clinical dental students who were ready to perform their first periodontal surgery were selected. Students were randomly assigned to two groups and were given a 60-min session on stress reduction. Group A, yogic intervention group, were instructed to do yoga and their performances were monitored for a period of one week and Group B, control group, were given a lecture on stress reduction without any yoga instructions. The investigator who was unaware of the groups had taken the state trait anxiety score of the students three times a) before assigning them to each group, b) prior to the surgical procedure and c) immediately after the performance of surgery. Statistical Analysis Used: Analyses of variance (ANOVA) by SPSS V.16. Results: The statistical results showed a significant reduction in the VAS and state trait anxiety of Group A compared to Group B (ANOVA; P<0.001). Conclusions: This study concludes that Yogic breathing has a significant effect on the reduction of state trait anxiety level of dental students.

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Aim: To describe the possible barriers to yoga therapy for patients with schizophrenia in India. Materials and Methods: In a randomized control trial at NIMHANS, patients with schizophrenia (on stable doses of antipsychotics, 18-60 years of age, with a Clinical Global Impression-Severity score of 3 or more) were randomized into one of three limbs: Yoga therapy, physical exercise and waitlist. Of 857 patients screened, 392 (45.7%) patients were found eligible for the study. Among them, 223 (56.8%) declined to take part in the trial. The primary reasons for declining were analyzed. Results: The primary reasons for declining were (a) distance from the center (n=83; 37.2%); (b) no one to accompany them for training (n=25; 11.2%); (c) busy work schedule (n=21, 9.4%); (d) unwilling to come for one month (n=11; 4.9%), (e) not willing for yoga therapy (n=9, 4.0%); (f) personal reasons (n=3, 1.3%); (g) religious reasons (n=1, 0.4%). In 70 patients (31.6%), no reasons were ascribed. No patient refused citing research nature of the intervention as a reason. Conclusion: More than half of the patients eligible for yoga did not consent to the study. Logistic factors, such as the need for daily training under supervision in a specialized center for long periods, are the most important barriers that prevent patients with schizophrenia from receiving yoga therapy. Alternative models/schedules that are patient-friendly must be explored to reach the benefit of yoga to patients with schizophrenia.

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Background: Practicing yoga has been shown to improve motor functions and attention. Though attention is required for fine motor and discrimination tasks, the effect of yoga breathing techniques on fine motor skills and visual discrimination has not been assessed. Aim: To study the effect of yoga breathing techniques on finger dexterity and visual discrimination. Materials and Methods: The present study consisted of one hundred and forty subjects who had enrolled for stress management. They were randomly divided into two groups, one group practiced high frequency yoga breathing while the other group practiced breath awareness. High frequency yoga breathing (kapalabhati, breath rate 1.0 Hz) and breath awareness are two yoga practices which improve attention. The immediate effect of high frequency yoga breathing and breath awareness (i) were assessed on the performance on the O'Connor finger dexterity task and (ii) (in) a shape and size discrimination task. Results: There was a significant improvement in the finger dexterity task by 19% after kapalabhati and 9% after breath awareness (P<0.001 in both cases, repeated measures ANOVA and post-hoc analyses). There was a significant reduction (P<0.001) in error (41% after kapalabhati and 21% after breath awareness) as well as time taken to complete the shape and size discrimination test (15% after kapalabhati and 15% after breath awareness; P<0.001) was also observed. Conclusion: Both kapalabahati and breath awareness can improve fine motor skills and visual discrimination, with a greater magnitude of change after kapalabhati.

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Context and Aim: Yoga has been found to be effective in the management of stress. This paper describes the development of a yoga program aimed to reduce burden and improve coping of family caregivers of inpatients with schizophrenia in India. Materials and Methods: Based on the assessment of caregiver needs, literature review, and expert opinion, a ten-day group yoga program was initially developed using the qualitative inductive method of inquiry. Each day's program included warm-up exercises, yogic asanas, pranayama, and satsang. A structured questionnaire eliciting comments on each day's contents was given independently to ten experienced yoga professionals working in the field of health for validation. The final version of the program was pilot-tested on a group of six caregivers of in-patients with schizophrenia admitted at NIMHANS, Bangalore. Results: On the question of whether the program would help reduce the burden of caregivers, six of the ten experts (60%) gave a rank of four of five (very much useful). Based on comments of the experts, several changes were made to the program. In the pilot-testing stage, more than 60% of the caregivers assigned a score of four and above (on a five-point Likert scale, five being extremely useful) for the overall program, handouts distributed, and performance of the trainer. Qualitative feedback of the caregivers further endorsed the feasibility and usefulness of the program. Conclusion: The developed yoga program was found to be acceptable to caregivers of in-patients with schizophrenia.

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