International Journal of Yoga
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   2019| September-December  | Volume 12 | Issue 3  
    Online since September 3, 2019

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Niyantrita Madhumeha Bharata 2017, methodology for a nationwide diabetes prevalence estimate: Part 1
HR Nagendra, R Nagarathna, SK Rajesh, S Amit, S Telles, A Hankey
September-December 2019, 12(3):179-192
DOI:10.4103/ijoy.IJOY_40_18  PMID:31543627
Background: Type 2 Diabetes Mellitus (T2DM) poses an ever-increasing threat to people's health worldwide. India has reported high rates of incidence of T2DM. The dangers make accurate assessment of its burden and intervention of lifestyle change, an urgent necessity. Aims and Objectives: The aim of the study was to estimate the nationwide prevalence of prediabetes and diabetes, followed by a translational lifestyle trial. Methodology: The Indian Yoga Association was commissioned in 2016–2017 by the Government of India to conduct this study which was undertaken in two phases: Phase 1 was to estimate the prevalence of prediabetes and diabetes across the country, and Phase 2 was to conduct a randomized controlled trial using a validated yoga lifestyle protocol. This paper highlights the unique methodology of Phase 1 of the study. The first stage was screening (February to April 2017) for adults (>20 years) with high risk for diabetes on Indian diabetes risk score (IDRS) on mobile app, using a random cluster sampling survey method. All households in the rural (4 villages with about 500 adult population/village) and urban (2 census enumeration blocks [CEBs] of about 1000 adult population/block) sectors of 65 districts (one per ten districts in the entire country) from 29 out of 35 states of India were approached. In the second stage, detailed assessments (sociodemographic, clinical details, A1c, lipid profile, body mass index, stress, and tobacco) were carried out on those with high risk on IDRS and on all self-reported diabetes individuals. Results: In the first stage of door-to-door visit, 240,968 adults in all households of the selected clusters of villages and CEBs were approached. Of these, 162,330 responded. The respondents in the second stage for detailed assessments in the selected cohort were 50,199 (48% rural and 52% urban) adults. Of these, 7472 were self-reported known diabetes adults and the remaining were 42,737. Prevalence estimates for the country will follow in the future publications. Conclusion: This rapid survey completed within 3 months in the entire country using trained volunteers offers the methodology to obtain a quick estimate of diabetes and high-risk population to implement any lifestyle program.
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Methodology of Niyantrita Madhumeha Bharata Abhiyaan- 2017, a nationwide multicentric trial on the effect of a validated culturally acceptable lifestyle intervention for primary prevention of diabetes: Part 2
R Nagarathna, SK Rajesh, S Amit, S Patil, A Anand, HR Nagendra
September-December 2019, 12(3):193-205
DOI:10.4103/ijoy.IJOY_38_19  PMID:31543628
Background: The rapidly increasing diabetes burden, reaching epidemic proportions despite decades of efforts, reflects our failure to translate the proven evidence for prevention of diabetes. Yoga, with its holistic approach, alters the habituated patterns of lifestyles and behaviour. Motivated by the accumulating evidence, the Government of India funded a large randomized controlled trial. Aims and Objectives: The twin objectives were: (a) estimate the prevalence of prediabetes and diabetes through a parallel multisite stratified cluster sampling method and (b) implement NMB 2017 (niyantrita madhumeha bharata abhiyaan), a randomized control trial using yoga based lifestyle program. Materials and Methods: Screening for Indian Diabetes Risk score(IDRS) was conducted in randomly selected clusters in all 7 zones (65 districts from 29 states/union territories) of India. This was followed by detailed assessments in those with known diabetes and high risk (≥60) on IDRS. Those who satisfied the selection criteria and consented were recruited for the two armed waitlisted randomized control trial. A validated remedial diabetesspecific integrated yoga lifestyle module was taught to the experimental arm by certified volunteers of Indian Yoga Association. Followup assessments were done after 3 months in both groups. In this article, we report the methodology of the trial. Results: Response to door to door visits (n-240,968 adults >20yrs) in randomly selected urban and rural households for screening was 162,330; detailed assessments (A1c, lipid profile, BMI, stress, tobacco etc) were performed on 50,199 individuals. Of these 12466 (6531 yoga 5935 control) consented and for the RCT; 52% females, 48% males; 38% rural, 62% urban; BMI 21.1 ± 3.8; waist circumference 91.7 ± 11.9. A1c in diabetes subjects in yoga group was 7.63 ± 2.17 and 7.86 ± 2.13 in control group. Conclusion: This unique methodology provides the evidence to implement a validated yoga life style module using yoga volunteers in all parts of the country which is an urgent need to prevent India from becoming the global capital for diabetes.
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A Cross-sectional and longitudinal study of the effects of a mindfulness meditation mobile application platform on reducing stress and anxiety
Shanthi Lakshmi Duraimani
September-December 2019, 12(3):226-232
DOI:10.4103/ijoy.IJOY_56_18  PMID:31543631
Introduction: The development of many lifestyle-related chronic disorders occurs as a result of stress and anxiety. In recent years, in order to overcome lifestyle-related problems, people are increasingly making use of mindfulness meditation mobile applications despite the fact that there is no substantial evidence that this practice has benefits for their health. Aim: Testing the effectiveness of this method in reducing stress and anxiety through the development of a mindfulness meditation mobile application was the aim of this project. Methodology: Two independent studies were conducted. For both the studies, IBM SPSS Statistics 23.0 software was used to perform the statistical analysis. The first study was conducted cross-sectionally between 111 meditators and 111 non-meditators. The use of Depression, Anxiety, Stress Scale (DASS) was employed in assessing the stress and anxiety. It was found out that stress (P < 0.000) and anxiety (P < 0.000) are significantly reduced for meditators in comparison with the non-meditators. A substantial reduction was observed using the cross-sectional study, and a longitudinal study was carried out to affirm the effectiveness of this method in reducing stress and anxiety. 67 users were shortlisted for the study and their stress and anxiety level was measured before and after practicing mindfulness meditation. Result: The result revealed that there was a substantial reduction in stress (P = 0.01) and anxiety (P = 0.02). Conclusion: Therefore, mindfulness meditation mobile application can serve as another medium of delivery in addressing the problems of stress and anxiety. However, future research is warranted to determine the biological effects of mindfulness meditation.
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Performance in a Corsi block-tapping task following high-frequency yoga breathing or breath awareness
Ram Kumar Gupta, Savita Agnihotri, Shirley Telles, Acharya Balkrishna
September-December 2019, 12(3):247-251
DOI:10.4103/ijoy.IJOY_55_18  PMID:31543634
Background: Uninostril yoga breathing practices have improved spatial memory scores. There has been no assessment on the effect of high-frequency yoga breathing (HFYB) on working memory and spatial memory scores using the Corsi block-tapping task (CBTT). Objectives: The present study was planned to assess the immediate effects of HFYB and breath awareness (BAW) compared to a control session on performance in a CBTT. Methods: Fifteen participants of both sexes with ages between 18 and 24 years (group mean age ± standard deviation, 20.0 ± 1.6 years; 10 females) were recruited for the trial from a university in North India. Each participant was assessed in three sessions conducted on 3 separate days at the same time of the day. The three sessions were (i) HFYB, (ii) BAW, and (iii) quiet sitting (QS). The duration of the intervention was 18 min. The participants were assessed before and after all the three sessions. Repeated-measures-analyses of variance followed by post hoc tests with Bonferroni adjustment were performed to compare data before and after all the three sessions. Results: BAW resulted in an improvement in backward total scores (P < 0.05) and the backward Corsi span (P < 0.05; one tailed). Conclusions: The results suggest that BAW improves primary working memory, spatial memory, and spatial attention. HFYB did not cause any change.
  4 3,660 259
Physical and physiological effects of yoga for an underserved population with chronic low back pain
Yvonne M Colgrove, Nicole S Gravino-Dunn, Sarah C Dinyer, Emily A Sis, Alexa C Heier, Neena K Sharma
September-December 2019, 12(3):252-264
DOI:10.4103/ijoy.IJOY_78_18  PMID:31543635
Background: Yoga has been shown useful in reducing chronic low back pain (CLBP) through largely unknown mechanisms. The aim of this pilot study is to investigate the feasibility of providing yoga intervention to a predominantly underserved population and explore the potential mechanisms underlying yoga intervention in improving CLBP pain. Methods: The quasi-experimental within-subject wait-listed crossover design targeted the recruitment of low-income participants who received twice-weekly group yoga for 12 weeks, following 6–12 weeks of no intervention. Outcome measures were taken at baseline, preintervention (6–12 weeks following baseline), and then postintervention. Outcome measures included pain, disability, core strength, flexibility, and plasma tumor necrosis factor (TNF)-α protein levels. Outcomes measures were analyzed by one-way ANOVA and paired one-tailed t-tests. Results: Eight patients completed the intervention. Significant improvements in pain scores measured over time were supported by the significant improvement in pre- and post-yoga session pain scores. Significant improvements were also seen in the Oswestry Disability Questionnaire scores, spinal and hip flexor flexibility, and strength of core muscles following yoga. Six participants saw a 28.6%–100% reduction of TNF-α plasma protein levels after yoga, while one showed an 82.4% increase. Two participants had no detectable levels to begin with. Brain imaging analysis shows interesting increases in N-acetylaspartate in the dorsolateral prefrontal cortex and thalamus. Conclusion: Yoga appears effective in reducing pain and disability in a low-income CLBP population and in part works by increasing flexibility and core strength. Changes in TNF-α protein levels should be further investigated for its influence on pain pathways.
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Changes in lung function measures following Bhastrika Pranayama (bellows breath) and running in healthy individuals
Rana Bal Budhi, Sandeep Payghan, Singh Deepeshwar
September-December 2019, 12(3):233-239
DOI:10.4103/ijoy.IJOY_43_18  PMID:31543632
Background: The purpose of this study was to observe the effect of bhastrika pranayama (bellows breath) and exercise on lung function of healthy individuals. Materials and Methods: A total of thirty male participants were recruited and randomly divided into two groups, i.e., yoga breathing group (YBG, n = 15) and physical exercise group (PEG, n = 15), and the participants' ages ranged between 18 and 30 years (group age mean ± standard deviation, 22.5 ± 1.9 years). YBG practiced bhastrika pranayama for 15 min, whereas PEG practiced running for 15 min, 6 days in a week, over a period of 1 month. The participants were assessed for (i) forced vital capacity (FVC), (ii) forced expiratory volume in the first second (FEV1), (iii) peak expiratory flow rate (PEFR), and (iv) maximum voluntary ventilation (MVV) functions of lungs. Results: Repeated-measures analyses of variance with Bonferroni adjustment post hoc analyses of multiple comparisons showed that there was a significant increase in YBG for all variables, i.e., FVC, FEV1, PEFR, and MVV (P < 0.001, P < 0.001, P < 0.01, and P < 0.001, respectively), whereas there was a significant increase in PEFR and MVV (P < 0.05 and P < 0.01, respectively) only, among PEG. However, the change in PEG was less of magnitude as compared to YBG. Conclusions: These findings demonstrate that incorporating pranayama in sports can enhance the efficiency of healthy individuals and athletes by enhancing the ventilatory functions of lungs, especially for those who partake in aerobic-based sports and require efficient lungs to deliver sufficient oxygen uptake.
  2 5,115 279
Effects of yoga asana practice approach on types of benefits experienced
Christine Wiese, David Keil, Anne S Rasmussen, Rikke Olesen
September-December 2019, 12(3):218-225
DOI:10.4103/ijoy.IJOY_81_18  PMID:31543630
Context: Modern science and the classic text on hatha yoga, Hatha Yoga Pradipika, report physical, mental, emotional, spiritual, and relational benefits of yoga practice. While all have specific suggestions for how to practice, little research has been done to ascertain whether specific practice approaches impact the benefits experienced by practitioners. Aims: Our aim was to relate the experience level of the practitioner, the context of practice approaches (time of day, duration of practice, frequency of practice, etc.), and experience level of the teacher, to the likelihood of reporting particular benefits of yoga. Methods: We conducted a cross-sectional descriptive survey of yoga practitioners across levels and styles of practice. Data were compiled from a large voluntary convenience sample (n = 2620) regarding respondents' methods of practice, yoga experience levels, and benefits experienced. Multiple logistic regression was used to identify approaches to yoga practice that positively predicted particular benefits. Results: Frequency of practice, either with or without a teacher, was a positive predictor of reporting nearly all benefits of yoga, with an increased likelihood of experiencing most benefits when the practitioner did yoga five or more days per week. Other aspects of practice approach, experience level of the practitioner, and the experience level of the teacher, had less effect on the benefits reported. Conclusions: Practice frequency of at least 5 days per week will provide practitioners with the greatest amount of benefit across all categories of benefits. Other practice approaches can vary more widely without having a marked impact on most benefits experienced.
  2 5,525 266
The impact of a daily yoga program for women with fibromyalgia
Asimina Lazaridou, Alexandra Koulouris, Kathleen Dorado, Peter Chai, Robert R Edwards, Kristin L Schreiber
September-December 2019, 12(3):206-217
DOI:10.4103/ijoy.IJOY_72_18  PMID:31543629
Background: Fibromyalgia (FM) is characterized by widespread pain, sleep disturbance, negative affect, and stress and is notably difficult to treat. Individuals with FM have lower physical activity and endorse fears that exercise may worsen pain. Gentle daily yoga practice may allow a gradual increase in activity and positively impact many of these FM symptoms. This qualitative study investigated the impact of participation in a pilot trial of group and daily individual home yoga intervention on women with FM. Materials and Methods: Fifteen individuals participated in telephone interviews after participating in the yoga intervention, which included semi-structured questions to elicit insights and impressions of their experience. Responses were systematically coded and themes identified. Results: Five themes were identified: (1) physical/body perceptual changes, (2) practices affecting pain, (3) emotional changes, (4) practice motivators and barriers, and (5) group effect. Participants not only reported reductions in FM symptoms, including pain and stress, but also a positive impact on mood, sleep, and self-confidence. Conclusions: Participants enumerated both physical and psychological impact of starting yoga practice. Specific helpful poses and practices and important barriers were identified. Group practice and social connection with others with other FM patients was an important benefit to participants.
  1 4,577 193
Can yoga practice minimize cancer risks to Indian women?
Govindasamy Agoramoorthy
September-December 2019, 12(3):177-178
DOI:10.4103/ijoy.IJOY_14_19  PMID:31543626
  - 2,902 115
A mathematical method for electromyography analysis of muscle functions during yogasana
V Devaraju, Ashitha Besagarahalli Ramesh, K Kshamith Alva, V Ramesh Debur, SN Omkar
September-December 2019, 12(3):240-246
DOI:10.4103/ijoy.IJOY_63_18  PMID:31543633
Context: For the past few decades, the number of people practicing yoga is increasing in number. Yogasanas need smooth body movements in the process of attaining defined postures that the person must hold on to activate specific muscles of the body related to that asana. Yogasanas should be performed with perfection to derive maximum benefits. Objective: The objective of this study was to introduce a mathematical method to understand muscle functionalities while doing Yogasanas. Materials and Methods: Used Delsys surface electromyography (sEMG) – TrignoTM (Delsys Inc.) sensors for data recording and analyzing muscle activation patterns. Results: Performance analysis was quantified using normalized sEMG signals. The sEMG data during final posture were fit to a straight line using linear regression analysis. Conclusion: The results suggested that the slope of the best fit line is a good metric for monitoring the muscle activity during Yoga performance. The advantages of this method are the slope of the line is a good indicator for monitoring the muscle activity while doing Yogasana and the method suggested in this study can be extended for analyzing other asanas as well.
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