Background: Nonspecific chronic low back (nCLBP) pain is prevalent among adult population and often leads to functional limitations, psychological symptoms, lower quality of life (QOL), and higher healthcare costs. The purpose of this study was to determine the efficacy of Iyengar yoga therapy on pain intensity and health related quality of life (HRQOL) with nCLBP. Aim of the Study: To compare the effect of Iyengar yoga therapy and conventional exercise therapy on pain intensity and HRQOL in nonspecific chronic low back pain. Materials and Methods: Experimental study with random sampling technique. Subjects/Intervention: Sixty subjects who fulfilled the selection criteria were randomly assigned to Iyengar yoga (yoga group, n = 30) and control group (exercise group, n = 30). Participants completed low back pain evaluation form and HRQOL-4 questionnaire before their intervention and again 4 weeks and 6 month later. Yoga group underwent 29 yogic postures training and exercise group had undergone general exercise program for 4 weeks. Statistics: Repeated measures analysis of variance (ANOVA) was used to analyze group differences over time, while controlling for baseline differences. Results: Patients in both groups experienced significant reduction in pain and improvement in HRQOL. In visual analogue scale (VAS) yoga group showed reduction of 72.81% ( P = 0.001) as compared to exercise group 42.50% ( P = 0.001). In HRQOL, yoga group showed reduction of 86.99% ( P = 0.001) as compared to exercise group 67.66% ( P = 0.001). Conclusion: These results suggest that Iyengar yoga provides better improvement in pain reduction and improvement in HRQOL in nonspecific chronic back pain than general exercise.

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Aim: The aim of this study was to define, decode, and append to the conceptual frame-work of the integrated approach to yoga therapy (IAYT). Materials and Methods: Four stakeholders who followed two in-patients with depression over a period of 2 weeks in the residential center "Arogyadhama" (of Swami Vivekananda Yoga Anusandana Samsthana, Bangalore, India) were interviewed before the start of the IAYT treatment and prior to discharge of the patient. The patients were also interviewed pre and post and were observed once during their session. The data from the audio recordings from eight in-depth interviews were transcribed manually and qualitative analysis was conducted. Results: The conceptual frame-work of IAYT depicts that patient related factors ("co-operation of patient," "patients awareness of his/her condition"), therapist related factors ("ability to guide," the "assistance to the patients," "explanation of the exercises") and treatment related factors ("combination of psychiatric or Ayurvedic medication with yoga," "counseling during the IAYT treatment," duration of treatment), play an integrated role in reaching the "aim of IAYT" and experiencing "improvements and changes." Conclusion: The IAYT is a holistic program and the ability of the patient to cooperate with and integrate the available factors (therapist related and treatment related) could enable best results.

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Background: Recent studies have reported the differential physiological and psychological effects of yogic uninostril breathing (UNB) and alternate nostril breathing (ANB) techniques. This study aims to determine differential effects of these techniques on reaction time (RT), heart rate (HR), and blood pressure (BP). Materials and Methods: Twenty yoga-trained subjects came to the lab on six different days and RT, HR, and BP were recorded randomly before and after nine rounds of right UNB (surya nadi [SN]), left UNB (chandra nadi [CN]), right initiated ANB (surya bhedana [SB]), left initiated ANB (chandra bhedana [CB]), nadi shuddhi (NS), and normal breathing (NB). Results: Overall comparison of ∆ % changes showed statistically significant differences between groups for all parameters. There was an overall reduction in HR- and BP-based parameters following CB, CN, and NS with concurrent increases following SB and SN. The differential effects of right nostril initiated (SB and SN) and left nostril initiated (CB, CN, and NS) UNB and ANB techniques were clearly evidenced. Changes following NB were insignificant in all respects. The overall comparison of ∆ % changes for RT showed statistically significant differences between groups that were significantly lowered following both SB and SN. Discussion and Conclusion: Our study provides evidence of sympathomimetic effects of right nostril initiated pranayamas with sympatholytic/parasympathomimetic effect following left nostril initiated pranayamas. We suggest that the main effect of UNB and ANB techniques is determined by the nostril used for inspiration rather than that used for expiration. We conclude that right and left yogic UNB and ANB techniques have differential physiological effects that are in tune with the traditional swara yoga concept that air flow through right nostril (SN and pingala swara) is activatory in nature, whereas the flow through left nostril (CN and ida swara) is relaxatory.

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Myofascial Pain Syndrome (MPS) refers to pain attributed to muscle and its surrounding fascia, which is associated with ''myofascial trigger points'' (MTrPs). MTrPs in the trapezius has been proposed as the main cause of temporal and cervicogenic headache and neck pain. Literature shows that the prevalence of various musculoskeletal disorders (MSD) among physiotherapists is high. Yoga has traditionally been used to treat MSDs in various populations. But there is scarcity of literature which explains the effects of yoga on reducing MPS of the neck in terms of various physical parameters and subjective responses. Therefore, a pilot study was done among eight physiotherapists with minimum six months of experience. A structured yoga protocol was designed and implemented for five days in a week for four weeks. The outcome variables were Disability of Arm, Shoulder and Hands (DASH) score, Neck Disability Index (NDI), Visual Analogue Scale (VAS), Pressure Pain Threshold (PPT) for Trigger Points, Cervical Range of Motion (CROM) - active & passive, grip and pinch strengths. The variables were compared before and after the intervention. Finally, the result revealed that all the variables (DASH: P<0.00, NDI: P<0.00, VAS: P<0.00, PPT: Left: P<0.00, PPT: Right: P<0.00, Grip strength: left: P<0.00, Grip strength: right: P<0.01, Key pinch: left: P<0.01, Key pinch: right: P<0.01, Palmar pinch: left: P<0.01, Palmar pinch: right: P<0.00, Tip pinch: left: P<0.01, Tip pinch: Right: P<0.01) improved significantly after intervention.

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Context: The promotion of yoga practice as a preventative and treatment therapy for health outcomes in the western hemisphere is increasing rapidly. As the commercial success of yoga burgeons in popular culture, it is important to investigate the trends of yoga as a therapeutic intervention in academic literature. The free-access search engine, PubMed is a preeminent resource to identify health-related research articles published for academics, health practitioners and others. Aims: To report the recent yoga-related publications in the western healthcare context with particular interest in the subject and type of yoga titles. Materials and Methods: A bibliometric analysis to describe the annual trends in publication on PubMed from January 1950 to December 2012. Results: The number of yoga-related titles included in the PubMed database is limited until a marked increase 2000 and steady surge since 2007. Bibliometric analysis indicates that more than 200 new titles are added per annum since 2011. Systematic reviews and yoga trials are increasing exponentially, indicating a potential increase in the quality of evidence. Titles including pain management, stress or anxiety, depression and cancer conditions are highly correlated with yoga and healthcare research. Conclusions: The prevalence of yoga research in western healthcare is increasing. The marked increase in volume indicates the need for more systematic analysis of the literature in terms of quality and results.

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Context: Research on the effect of Thoppukaranam is limited despite it being practiced as a form of worship to the elephant-headed deity Lord Ganapati and punishment in schools. Aims: The purpose of this study was to examine the effect of Thoppukaranam on selective attention and psychological states in a sample of young adults. Settings and Designs: A randomized self-as-control within subjects design was employed. Thirty undergraduate students (4 females and 26 males) from a residential Yoga University in Southern India were recruited for this study (group mean age ± standard deviation, 20.17 ± 2.92). Materials and Methods: The d2 test, State Anxiety Inventory-Short Form and State Mindful Attention Awareness Scale (SMAAS) were used to measure cognitive performance and psychological states. Assessments were made in three sessions: Baseline, control (squats), and experimental (Thoppukaranam) on 3 separate days. Statistical analysis used : Data were analyzed using one-way repeated measures analyses of variance between three sessions, that is, baseline, squat, and Thoppukaranam. Results: There was a significant improvement in all measures of the d2 test of attention (TN, E, TN-E, E%, and concentration performance) and state mindfulness after Thoppukaranam. Further state anxiety reduced significantly after the experimental session. Conclusions: These findings indicate Thoppukaranam results in enhancement of cognitive functioning and psychological states.

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Objectives: To document and explain Yoga's effects on acupuncture meridian energies. To understand mechanisms behind Yoga's efficacy by testing links between yoga and traditional Chinese medicine. Materials and Methods: The study compared two groups of yoga practitioners: Novice and experienced. Novices consisted of 33 volunteers from a Swami Vivekananda Yoga Anusandhana Samsthana (S-VYASA) yoga instructor training module and the experienced practitioners were 20 resident SVYASA students. The intervention was 3 weeks of a yoga training program, new for the novices, but the lifestyle of the experienced group, who were therefore assessed only once. Novices were assessed on day 2 and 23 of their program at SVYASA's Yoga Medicine Hospital, making their data a pre-post, self-as-control, prospective study. Main outcome measures were mean acumeridian energy levels assessed by AcuGraph3 measures of electrodermal resistance at acupoints; additionally, gender differences, standard deviations (SDs) of all measures, and comparison of post and experienced group data. Results: Averaged energy levels significantly improved in all 24 meridians (maximum P = 0.032, 4-P < 0.01, and 19-P < 0.001). Females improved more than males (P < 0.05), both ending at similar levels to experienced practitioners, whose SDs were lower than novices on 19/24 meridians (mean F = 3.715, P = 0.0022), and 4/5 average variables. Conclusions: AcuGraph3 electrodermal measures contain substantial information, P << 0.00001. Yoga-lifestyle practice can increase and balance acumeridian energies; long-term practice decreases group SD's. These three suggest reasons why yoga practice impacts health: One, increased prana levels are important; two and three, improved physiological regulation is the key. Further studies relating traditional Indian and Chinese medical systems are needed.

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Context: Clinical benefits of yoga have been well explored, but factors contributing to adherence to regular yoga practice are not well studied. Aims: To study the factors influencing adherence to yoga practices on those participants who have completed 1-month Yoga Instructors' course from a yoga university. Settings and Design: Online survey was conducted on participants who had finished 1-month Yoga Instructors' course at a yoga university. Materials and Methods: Online survey was conducted using Survey Monkey web portal with response rate of 42.5%. A total of 1355 participants were approached. Demographic items and a checklist of 21 items on a 5-point likert scale were prepared based on traditional yoga texts. A few items to assess modern lifestyle barriers were also included. Statistical Analysis: One-sample proportion test with chi square statistics was used for analysis. Results: Irregularity in lifestyle, family commitments, and occupational commitments are perceived as significant strong barriers. Dullness, excessive talking, strictly adhering to rules, laziness, physical and mental overexertion, fickleness and wandering of mind, unsteadiness of mind, procrastination, and oversleeping are considered as significant barriers of moderate nature. Conclusions: Modern lifestyle is the major challenge for yoga practitioners to adhere to regular practice of yoga. To address this, attention is required in strengthening the lifestyle management and the spiritual dimension of yoga practice as the spiritual component seems to be side-tracked.

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Background: Asthma is a chronic inflammatory disorder of the airways. The chronic inflammation causes an associated increase in airway hyperresponsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness, and coughing at night or in the early morning. Most of the studies have reported, as the effects of yoga on bronchial asthma, significant improvements in pulmonary functions, quality of life, and decrease in medication use, but none of the studies has attempted to show the effect of yoga on biochemical changes. Objective: To evaluate the effect of yoga on biochemical profile of asthmatics. Materials and Methods: In the present study, 276 patients of mild to moderate asthma (FEV ₁ > 60%) aged between 12 to 60 years were recruited from the Department of Pulmonary Medicine, King George's Medical University, U.P., Lucknow, India. They were randomly divided into two groups: Yoga group (with standard medical treatment and yogic intervention) and control group as standard medical treatment (without yogic intervention). At completion of 6 months of the study period, 35 subjects were dropped out, so out of 276 subjects, only 241 subjects completed the whole study (121 subjects from yoga group and 120 subjects from control group). Biochemical assessment was carried out at baseline and after 6 months of the study period. Results: In yoga group, there was significant improvement found in the proportion of hemoglobin and antioxidant superoxide dismutase in comparison to control group and significant decrease was found in total leukocyte count (TLC) and differential leukocytes count in comparison to control group. There was no significant change found in TLC, polymorphs, and monocytes in between group comparison. Conclusions: Yoga group got significantly better improvement in biochemical variables than control group. Result shows that yoga can be practiced as adjuvant therapy with standard inhalation therapy for better outcome of asthma.

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Background: Yoga is an increasingly accepted complementary treatment modality for referral in Australian general practice, yet this practitioner group has largely escaped research attention in Australia. Complementary medicine use is highest in rural and regional areas, where a number of primary health care challenges are also more pronounced. Despite the significant role of complementary therapists in rural and regional Australia, and the increasing acceptance of yoga therapy in general practice, there has been little exploration of the interface between yoga therapists and conventional primary health care practitioners in this area. Materials and Methods: A 27-item questionnaire was sent to all 1486 general practitioners (GPs) currently practising in rural and regional Divisions of General Practice in New South Wales, Australia. Results: Completed questionnaires were returned by 585 GPs, with 49 returned as 'no longer at this address' (response rate 40.7%). One-in-eight GPs (12.1%) advised their patients of specific yoga therapies and protocols, and 7.2% advised specific meditation techniques. Three-quarters of GPs (76.6%) referred to a yoga therapist at least a few times per year, with 12.5% of GPs referring at least once per week. GPs being in a remote location (OR = 10.95; CI: 1.55, 77.31), being female (OR = 1.85; 95% CI: 1.16, 2.94), GPs graduating from an Australian medical school (OR = 4.52; 95% CI: 2.61, 7.80), perceiving lack of other treatment options (OR = 3.29; 95% CI: 1.61, 6.74), GPs reporting good or very good knowledge of yoga therapies (OR = 18.2; 95% CI: 9.19, 36.19), and GPs using CAM for their own personal health (OR = 4.53; 95% CI: 2.60, 7.87) were all independently predictive of increased referral to yoga therapists amongst the rural GPs in this study. Conclusions: There is a significant interface between yoga therapists in Australian rural and regional general practice. There is generally high support for yoga therapies among Australian GPs, with low levels of opposition to the incorporation of these therapies in patient care. There is a need for increased research into yoga therapies practice, policy and regulation in these areas.

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Background: Surya Namaskar (SN), a popular traditional Indian yogic practice, includes practicing 12 physical postures with alternate forward and backward bending movement of the body along with deep breathing maneuvers. The practice of SN has become popular among yoga practitioners and other fitness conscious people. The long-term effect of practicing SN and other yogic practices on cardiorespiratory responses during SN are lacking. Aim: The present study was conducted to study the effect of yogic training on various cardiorespiratory responses during the SN practice in yoga trainees after a time interval of 3, 6, and 11 months. Materials and Methods: The present study was conducted on 9 healthy male Army soldiers who underwent training in various yoga postures including SN, meditation, and pranayama for 1 h daily for 11 months. First, second, and third phase of the study was conducted in the laboratory after completion of 3, 6, and 11 months of the yoga training. The participants performed SN along with other yogic practices in the laboratory as per their daily practice schedule. The cardiorespiratory responses of the volunteers were recorded during actual practice of SN. Statistical Analysis: One-way repeated measure ANOVA followed by Tukey HSD. Results: Oxygen consumption and heart rate during actual practice of SN was 0.794 ± 0.252, 0.738 ± 0.229, and 0.560 ± 0.165 L/min and 92.1 ± 11.6, 97.9 ± 7.3 and 87.4 ± 9.2 beats/min respectively at 1 ^st , 2 ^nd , and 3 ^rd phase of yoga training. Minute ventilation and tidal volume also reduced from 19.9 ± 4.65 to 17.8 ± 4.41 L/min and 1.091 ± 0.021 to 0.952 L/breath from 1 ^st phase to 3 ^rd phase of yoga training. However, respiratory parameters like breathing rate (f _R ) did not show any reduction across the three phases. Conclusion: The results of the present study indicated that yogic training caused conditioning of cardiorespiratory parameters except f _R, which did not reduce across three phases of training.

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Objective: To evaluate the effect of yoga on forced vital capacity (FVC), forced expiratory volume in I ^st second (FEV1), peak expiratory flow rate (PEFR), FEVI/FVC ratio, and pulmonary pressures [maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP) at the end of 3 months yoga training and the detraining effect on the above parameters in 7-9-years-old school going children. Materials and Methods: A total of 100 participants were recruited from a school in Bangalore. After baseline assessments, the participants were randomly allocated to either yoga or physical activity group. Intervention was given for 3 months, and measures of pulmonary function and pulmonary pressures were determined immediately post-intervention and at 3-months follow-up. Results: Although significant increase was observed in FVC, FEV1, PEFR, FEV1/FVC, MIP, and MEP at post-intervention, there were no significant differences between the two study groups after adjusting for height and age post training . However, MIP increased significantly in both the groups post-intervention, but the yoga group performed significantly higher than the PE group. The effects of training did not fade off even after 3 months of detraining. In fact, the FVC and FEV1 continued to increase significantly. A trend of decrease was observed in PEFR, MIP, and MEP. However, the values did not regress to the baseline value. Conclusions: This study suggests that practice of yoga for a short duration (3 months) of time can significantly improve respiratory muscle strength in pediatric population.

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