Full title: A systems biology approach to studying Tai Chi, physiological complexity and healthy aging: Design and rationale of a pragmatic randomized controlled trial.

INTRODUCTION: Aging is typically associated with progressive multi-system impairment that leads to decreased physical and cognitive function and reduced adaptability to stress. Due to its capacity to characterize complex dynamics within and between physiological systems, the emerging field of complex systems biology and its array of quantitative tools show great promise for improving our understanding of aging, monitoring senescence, and providing biomarkers for evaluating novel interventions, including promising mind-body exercises, that treat age-related disease and promote healthy aging.

MATERIAL AND METHODS: An ongoing, two-arm randomized clinical trial is evaluating the potential of Tai Chi mind-body exercise to attenuate age-related loss of complexity. A total of 60 Tai Chi-naïve healthy older adults (aged 50-79) are being randomized to either six months of Tai Chi training (n=30), or to a waitlist control receiving unaltered usual medical care (n=30). Our primary outcomes are complexity-based measures of heart rate, standing postural sway and gait stride interval dynamics assessed at 3 and 6months. Multiscale entropy and detrended fluctuation analysis are used as entropy- and fractal-based measures of complexity, respectively. Secondary outcomes include measures of physical and psychological function and tests of physiological adaptability also assessed at 3 and 6months.

DISCUSSION: Results of this study may lead to novel biomarkers that help us monitor and understand the physiological processes of aging and explore the potential benefits of Tai Chi and related mind-body exercises for healthy aging.

Contemp Clin Trials. 2013 Jan;34(1):21-34. doi: 10.1016/j.cct.2012.09.006. Epub 2012 Sep 29. Wayne PM, Manor B, Novak V, Costa MD, Hausdorff JM, Goldberger AL, Ahn AC, Yeh GY, Peng CK, Lough M, Davis RB, Quilty MT, Lipsitz LA. Osher Center for Integrative Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA. Electronic address: pwayne@partners.org.

Full title: Complementary medicine, exercise, meditation, diet, and lifestyle modification for anxiety disorders: a review of current evidence.

Use of complementary medicines and therapies (CAM) and modification of lifestyle factors such as physical activity, exercise, and diet are being increasingly considered as potential therapeutic options for anxiety disorders. The objective of this metareview was to examine evidence across a broad range of CAM and lifestyle interventions in the treatment of anxiety disorders. In early 2012 we conducted a literature search of PubMed, Scopus, CINAHL, Web of Science, PsycInfo, and the Cochrane Library, for key studies, systematic reviews, and metaanalyses in the area. Our paper found that in respect to treatment of generalized anxiety or specific disorders, CAM evidence revealed current support for the herbal medicine Kava. One isolated study shows benefit for naturopathic medicine, whereas acupuncture, yoga, and Tai chi have tentative supportive evidence, which is hampered by overall poor methodology. The breadth of evidence does not support homeopathy for treating anxiety. Strong support exists for lifestyle modifications including adoption of moderate exercise and mindfulness meditation, whereas dietary improvement, avoidance of caffeine, alcohol, and nicotine offer encouraging preliminary data. In conclusion, certain lifestyle modifications and some CAMs may provide a beneficial role in the treatment of anxiety disorders.

Evid Based Complement Alternat Med. 2012;2012:809653. Epub 2012 Aug 27. Sarris J, Moylan S, Camfield DA, Pase MP, Mischoulon D, Berk M, Jacka FN, Schweitzer I. Department of Psychiatry, The University of Melbourne, Melbourne, VIC 3000, Australia.

OBJECTIVE: The objective of this systematic review was to assess the effectiveness of yoga as a treatment option for any type of pain. METHOD: Seven databases were searched from their inception to February 2011. Randomized clinical trials were considered if they investigated yoga in patients with any type of pain and if they assessed pain as a primary outcome measure. The 5-point Jadad scale was used to assess methodological quality of studies. The selection of studies, data extraction and quality assessment were performed independently by two reviewers. RESULTS: Ten randomized clinical trials (RCTs) met the inclusion criteria. Their methodological quality ranged between 1 and 4 on the Jadad scale. Nine RCTs suggested that yoga leads to a significantly greater reduction in pain than various control interventions such as standard care, self care, therapeutic exercises, relaxing yoga, touch and manipulation, or no intervention. One RCT failed to provide between group differences in pain scores. CONCLUSIONS: It is concluded that yoga has the potential for alleviating pain. However, definitive judgments are not possible.

Complement Ther Med. 2011 Oct;19(5):281-7. Posadzki P, Ernst E, Terry R, Lee MS. Complementary Medicine, Peninsula Medical School, University of Exeter, Exeter, United Kingdom.

OBJECTIVES: Yoga improves cardiovascular health in both healthy individuals and those with diagnosed heart disease. This study compares changes in some cardiovascular parameters before and after the practice of Yoga in healthy medical students. METHODS: Sixty-four healthy medical students (57 females and 7 males), mean age 21.3 +/- 2.6 years, attending a Special Study Module 'Role of Dhyana Yoga in Stress Management', participated in this study. Systolic (SYS) and Diastolic (DIA) blood pressure, Heart Rate (HR), Stroke Volume (SV), Cardiac output (CO), Total Peripheral Resistance (TPR), Interbeat Interval (IBI), Left Ventricular Ejection Time (LVET), Arterial Compliance (Cwk) and Ascending Aorta Impedance (Zao) were measured before and after six weeks of yogic exercises. Various exercises included asanas (Postures), pranayama (Breathing), and dhyana (Meditation). Data were analyzed using Stata for Windows. RESULTS: Two-tailed paired t-test revealed that practice ofyoga caused significant increases in HR (p < 0.05), SV (p < 0.01), CO (p < 0.001) and Cwk (p < 0.01) and decreases in TPR (p < 0.001), IBI (p < 0.05) and Zao (p < 0.001) after practising yoga for 6 weeks as compared to before yoga practice. No significant differences were, however observed in SYS, DIA, Mean arterial blood pressure (MAP) and LVET CONCLUSIONS: Practice of yoga even for a short period showed ability to improve most of the cardiovascular functions. Regular practice of yoga for a longer period may further improve these functions and possibly result in improved management of their daily stress.

West Indian Med J. 2011 Mar;60(2):148-52. Parshad O, Richards A, Asnani M. Department of Basic Medical Sciences, Tropical Medicine Research Institute, The University of the West Indies, Kingston 7, Jamaica, West Indies.

Abstract Objectives: The study objectives were to develop and objectively assess the therapeutic effect of a novel movement-based complementary and alternative medicine approach for children with an autism-spectrum disorder (ASD). Design: A within-subject analysis comparing pre- to post-treatment scores on two standard measures of childhood behavioral problems was used. Settings and location: The intervention and data analysis occurred at a tertiary care, medical school teaching hospital. Subjects: Twenty-four (24) children aged 3-16 years with a diagnosis of an ASD comprised the study group. Intervention: The efficacy of an 8-week multimodal yoga, dance, and music therapy program based on the relaxation response (RR) was developed and examined. Outcome measures: The study outcome was measured using The Behavioral Assessment System for Children, Second Edition (BASC-2) and the Aberrant Behavioral Checklist (ABC). Results: Robust changes were found on the BASC-2, primarily for 5-12-year-old children. Unexpectedly, the post-treatment scores on the Atypicality scale of the BASC-2, which measures some of the core features of autism, changed significantly (p=0.003). Conclusions: A movement-based, modified RR program, involving yoga and dance, showed efficacy in treating behavioral and some core features of autism, particularly for latency-age children.

J Altern Complement Med. 2011 Oct 12. Rosenblatt LE, Gorantla S, Torres JA, Yarmush RS, Rao S, Park ER, Denninger JW, Benson H, Fricchione GL, Bernstein B, Levine JB. 1 Department of Psychiatry, Saint Francis Hospital and Medical Center , Hartford, CT.

FULL TITLE: Living AnatoME: Teaching and learning musculoskeletal anatomy through yoga and pilates.

Living AnatoME, a program designed in 2004 by two medical students in conjunction with the Director of Anatomy, teaches musculoskeletal anatomy through yoga and Pilates. Previously offered as an adjunct to the Gross Anatomy course in 2007, Living AnatoME became an official part of the curriculum. Previous research conducted on the program demonstrated its efficacy in providing relaxation and well-being to students who attended. In 2007, with all 144 gross anatomy students required to participate in a 1.5 hour Living AnatoME session on the upper and lower limbs, the impact of the program on students' comprehension of musculoskeletal anatomy was analyzed through the administration of 25-question pre- and post-tests, gauging knowledge in the following domains: upper limb, lower limb, muscle function, palpation, attachment/location, clinical correlate, and control (i.e., material not emphasized during the intervention). Analysis of postintervention tests revealed significant improvement in total Living AnatoME scores as well as in the domains of upper limb, muscle function, and palpation, indicating the possible efficacy of Living AnatoME in teaching anatomy. Performance on control questions also improved, although not significantly, which may indicate the role of other variables (e.g., additional study time) in increased performance.

Anat Sci Educ. 2010 Nov-Dec;3(6):279-86. doi: 10.1002/ase.181. McCulloch C, Marango SP, Friedman ES, Laitman JT. Center for Anatomy and Functional Morphology, Mount Sinai School of Medicine, New York, New York 10029-6574, USA. carrie.mcculloch@mssm.edu

FULL TITLE: Laughter yoga versus group exercise program in elderly depressed women: a randomized controlled trial.

BACKGROUND: Laughter Yoga founded by M. Kataria is a combination of unconditioned laughter and yogic breathing. Its effect on mental and physical aspects of healthy individuals was shown to be beneficial. OBJECTIVE: The objective of this study was to compare the effectiveness of Kataria's Laughter Yoga and group exercise therapy in decreasing depression and increasing life satisfaction in older adult women of a cultural community of Tehran, Iran. METHODS: Seventy depressed old women who were members of a cultural community of Tehran were chosen by Geriatric depression scale (score?>?10). After completion of Life Satisfaction Scale pre-test and demographic questionnaire, subjects were randomized into three groups of laughter therapy, exercise therapy, and control. Subsequently, depression post-test and life satisfaction post-test were done for all three groups. The data were analyzed using analysis of covariance and Bonferroni's correction. RESULTS: Sixty subjects completed the study. The analysis revealed a significant difference in decrease in depression scores of both Laughter Yoga and exercise therapy group in comparison to control group (p? Int J Geriatr Psychiatry. 2010 Sep 16. Shahidi M, Mojtahed A, Modabbernia A, Mojtahed M, Shafiabady A, Delavar A, Honari H. Department of Counseling, School of Psychology & Training Sciences, Allameh Tabatabai University, Tehran, Iran.

OBJECTIVE: Emerging research suggests that yoga may be beneficial for reducing symptoms and improving quality of life among breast cancer patients. However, very little is known about the characteristics of breast cancer patients who use yoga; thus, this study seeks to identify the sociodemographic and clinical characteristics of yoga users among this population. DESIGN: A cross-sectional survey study was conducted. SETTING: The study was conducted at an outpatient breast oncology clinic at a large university hospital. PARTICIPANTS: Three hundred postmenopausal breast cancer patients currently receiving aromatase inhibitors were included in this study. MAIN OUTCOME MEASUREMENT: Self-reported use of yoga following the cancer diagnosis was collected along with sociodemographic and clinical data. Multivariate logistic regression was used to identify independent predictors of yoga use among breast cancer patients. RESULTS: Of 300 participants, 53 (17.7%) reported having used yoga following cancer diagnosis. White patients were significantly more likely to use yoga than nonwhite patients (P = .02). Higher education level, lower BMI (body mass index), part-time employment status, previous chemotherapy, and radiation therapy were all associated with greater yoga use (all P < .05). Controlling for other factors, greater yoga use was independently associated with higher education level (adjusted odds ratio [AOR] 2.72, 95% confidence interval [CI], 1.15-6.46), and lower BMI (AOR 0.25, 95% CI, 0.09-0.66). CONCLUSION: Yoga use following breast cancer diagnosis was substantially higher for white patients and those with lower BMI and higher education levels. Considering its potential benefits for symptom management in cancer, more research is needed to understand the attitudes and barriers to yoga use among individuals with nonwhite race, lower education, and higher BMI level. Such investigation will help design yoga programs that are aligned to the needs of these populations.

Explore (NY). 2010 Nov-Dec;6(6):359-63. Desai K, Bowman MA, Galantino ML, Hughes-Halbert C, Vapiwala N, Demichele A, Mao JJ. Department of Family Medicine and Community Health, University of Pennsylvania Health System, Philadelphia, PA 19104.

FULL TITLE: Effect of a yoga programme on an individual with Parkinson's disease: a single-subject design.

Purpose.?To investigate the effect of eight weekly yoga sessions on balance, mobility and reported quality of life of an individual with Parkinson's disease (PD). Furthermore, to test the methodology in order to inform future research. Method.?A 69-year-old female with an 8-year history of PD (Hoehn and Yahr rating two) was selected for the study, which had a single subject ABA design. A 1-week baseline was followed by an 8-week period of weekly 60?min yoga classes and a further 5 weeks of treatment withdrawal. Main outcome measures used were Berg Balance Scale (BBS), Timed Up and Go (TUG) and the Parkinson's Disease Questionnaire-39 (PDQ-39); collected at baseline, before, during and after the intervention and at follow-up. Results.?An improvement was noted in the BBS and TUG during the intervention phase; although these changes did not appear to be clinically significant. No change in quality of life as measured by the PDQ-39 was noted. Conclusions.?The objective improvements in functional activities during the intervention period were not clinically significant. Subjectively, the participant gained much enjoyment and relaxation from the yoga classes. This study justifies the need for further studies using a larger sample size. Additionally, it will inform the methodological design.

Disabil Rehabil. 2010 Nov 4. Hall E, Verheyden G, Ashburn A. Rehabilitation Research Unit, University of Southampton, Southampton General Hospital, Level E, Southampton, UK.

FULL TITLE: Yoga and pilates: Associations with body image and disordered-eating behaviors in a population-based sample of young adults.

OBJECTIVE: To examine associations between participating in mind-body activities (yoga/Pilates) and body dissatisfaction and disordered eating (unhealthy and extreme weight control practices and binge eating) in a population-based sample of young adults. METHOD: The sample included 1,030 young men and 1,257 young women (mean age: 25.3 years, SD = 1.7) who participated in Project EAT-III (Eating and Activity in Teens and Young Adults). RESULTS: Among women, disordered eating was prevalent in yoga/Pilates participants and nonparticipants, with no differences between the groups. Men participating in yoga/Pilates were more likely to use extreme weight control behaviors (18.6% vs. 6.8%, p = .006) and binge eating (11.6% vs. 4.2%, p = .023), and marginally more likely to use unhealthy weight control behaviors (49.1% vs. 34.5%; p = .053), than nonparticipants after adjusting for sociodemographics, weight status, and overall physical activity. DISCUSSION: Findings suggest the importance of helping yoga/Pilates instructors recognize that their students may be at risk for disordered eating. © 2010 by Wiley Periodicals, Inc. Int J Eat Disord 2010.

Int J Eat Disord. 2010 Sep 22. Neumark-Sztainer D, Eisenberg ME, Wall M, Loth KA. Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minnesota.

Yoga is adjunctively utilized outside the United States in the treatment of a variety of diseases, including chronic obstructive pulmonary disease (COPD), but there are no studies assessing its adjunctive efficacy in the United States. We prospectively evaluated the effects of yoga training on the quality of life (QOL) and the parameters of lung function in patients with COPD. Thirty-three patients with documented COPD, per Global Initiative for Obstructive Lung Disease criteria, were recruited. All patients received standard COPD care. The QOL was assessed by the St. George Respiratory questionnaire. Standard spirometry and maximum inspiratory (maximal inspiratory pressure) and expiratory pressure (maximal expiratory pressure) were measured. Patients were taught selected yoga exercises including breathing exercises, meditation, and yoga postures for 1 hour, thrice a week for 6 weeks by a certified yoga therapist. The quality of life and lung function were again assessed at the end of 6 weeks. Twenty-two patients completed the study. Differences in preyoga versus postyoga scores were evaluated using paired t-tests. Statistically significant improvements (P < 0.05) were observed for the St. George Respiratory questionnaire [95% confidence interval (CI) 43.13-58.47], vital capacity (95% CI 2.53-7.65), maximal inspiratory pressure (95% CI 6.62-23.64), and maximal expiratory pressure (95% CI 1.63-13.81). Yoga when practiced by patients with COPD results in improvement in the QOL and lung function on a short-term basis. Additional research is needed to confirm these findings in a randomized controlled trial and in the longer term.

Am J Ther. 2010 Oct 22. Fulambarker A, Farooki B, Kheir F, Copur AS, Srinivasan L, Schultz S. 1Pulmonary Division, Department of Medicine, Rosalind Franklin University of Medicine and Science/The Chicago Medical School, North Chicago, IL; and 2VA Great Lakes Health Care System, North Chicago, IL.

FULL TITLE: A comparative study of complementary and alternative medicine use among heterosexually and lesbian identified women: data from the ESTHER Project

OBJECTIVES: The prevalence of complementary and alternative medicine (CAM) use among women in the United States is high. Little is known about how CAM use may differ based on sexual orientation. Study aims were to measure the prevalence of CAM use in a community sample of women, explore differences in CAM use patterns by sexual orientation, and identify correlates of CAM use. DESIGN/SUBJECTS: Analyses were based on women (Total N?=?879; n?=?479 lesbians) enrolled in the Epidemiologic STudy of HEalth Risk in Women (ESTHER) Project, a cross-sectional heart-disease risk-factor study. SETTINGS/LOCATION: Data were collected through convenience sampling of adult females in Pittsburgh, PA (2003-2006). OUTCOME MEASURES: Main outcome measures included lifetime and past 12-month CAM use, and types of CAM modalities used in the past 12 months. RESULTS: The prevalence of having ever used CAM was 49.8%, with 42% having reported CAM use within the past 12 months. Lesbians had greater odds of having ever used CAM (adjusted odds ratio [AOR]?=?1.68 [95% confidence interval (CI): 1.23, 2.28]) and of having used CAM in the past 12 months (AOR?=?1.44 [CI: 1.06, 1.97]) than heterosexuals. In multivariate analyses, correlates of lifetime and past 12-month CAM use included being lesbian, white, higher educated, and a large-city resident; experiencing perceived discrimination in a health care setting; and having a greater spirituality rating and a history of a diagnosed mental health disorder. Past 12-month CAM use was also associated with having a provider of usual health care. Among women who used CAM within the past 12 months, heterosexuals had significantly higher yoga participation rates than lesbians. CONCLUSIONS: Sexual orientation is important in understanding lifetime and past 12-month CAM use. Because of the high prevalence of CAM use found in this study, medical practitioners should inquire about the CAM practices of female patients, particularly lesbians.

(Pittsburgh, PA, 2003-2006). J Altern Complement Med. 2010 Nov;16(11):1161-70. Smith HA, Matthews A, Markovic N, Youk A, Danielson ME, Talbott EO. Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 230 McKee Street, Pittsburgh, PA 15213, USA. Smithha@upmc.edu

FULL TITLE: Characteristics and predictors of short-term outcomes in individuals self-selecting yoga or physical therapy for treatment of chronic low back pain.

OBJECTIVE: To compare clinical and demographic characteristics of individuals self-selecting yoga or physical therapy (PT) for treatment of chronic low back pain (cLBP) and to examine predictors of short-term pain and functional outcomes. DESIGN: Descriptive, longitudinal study. SETTINGS: A hospital-based clinic that offers modified integral yoga classes for cLBP and 2 outpatient PT clinics that offer exercise-based PT. PARTICIPANTS: Adults (n=53) with cLBP?12 weeks: yoga (n=27), PT (n=26). METHODS: Yoga participants attended a 6-week, once weekly, 2-hour yoga class. PT participants underwent twice weekly, 1-hour individualized PT. Data were collected at baseline and at 6 weeks. Groups were compared by using ?2 and independent samples t-tests. Hierarchical linear regression was used to predict treatment outcomes. MAIN OUTCOME MEASURES: Disability (Roland Morris Disability Questionnaire), health status (Rand Short Form 36 Health Survey 1.0), pain bothersomeness (numerical rating scale), back pain self-efficacy (Back Pain Self-Efficacy Scale), and treatment satisfaction. RESULTS: At baseline, yoga participants were significantly less disabled (P=.013), had higher health status (P=.023), greater pain self-efficacy (P=.012), and less average pain bothersomeness (P=.001) compared with PT participants. At 6 weeks, when controlling for baseline group differences, greater pain self-efficacy was the strongest predictor for reduced pain and higher function for the entire sample. A significant group interaction by baseline pain self-efficacy predicted disability at 6 weeks. PT participants with low pain self-efficacy reported significantly greater disability than those with high pain self-efficacy. Yoga participants with low and high pain self-efficacy had similar disability outcomes. CONCLUSION: These findings strengthen evidence that self-efficacy is associated with cLBP outcomes, especially in individuals self-selecting PT. Further research to evaluate outcomes after yoga and PT in participants with low pain self-efficacy is needed.

PM R. 2010 Nov;2(11):1006-15. Evans DD, Carter M, Panico R, Kimble L, Morlock JT, Spears MJ. Family and Community Nursing, Emory University Nell Hodgson Woodruff School of Nursing, 1520 Clifton Rd, Atlanta, GA 30322, USA. dian.evans@emoryhealthcare.org

FULL TITLE: Efficacy of bolus lukewarm saline and yoga postures as colonoscopy preparation: a pilot study.

BACKGROUND: Colonoscopy is now the gold standard for colon cancer screening and a vital diagnostic and therapeutic tool in 21st century medical practice. Although advances have been swift since colonoscopy came into wide use a generation ago, its effectiveness can be compromised by patients' ability to adequately prepare for the procedure. Many patients dread this task more than the procedure itself. While no prep regimen can be ideal for all patients, the authors present a novel approach that represents a potential time-saving improvement for younger, healthier patients. It is a modern version of an Indian practice called shankh prakshalana, in which lukewarm saline is used in combination with five yoga postures to cleanse the bowel. OBJECTIVE: The objective of this study was to examine the safety, efficacy, and tolerability of lukewarm saline and yoga (LWS/yoga) as a colonoscopy preparation in comparison with NuLytely(®) (PEG-3350, sodium chloride, sodium bicarbonate, and potassium chloride solution) used according to the manufacturer's instructions. RESEARCH DESIGN: This was a pilot study comprising 54 healthy adults, ages 18-65, equally divided into two groups: Group A preparing with lukewarm saline and yoga postures (LWS/yoga); and Group B preparing with NuLytely(®) as directed on the label. MEASUREMENTS: Data were collected on the quality of bowel preparation, patient safety, patient tolerability, and side-effects. The setting was a Joint Commission accredited outpatient endoscopy clinic. INTERVENTIONS: Patients performed the series of five yoga postures known as shankh prakshalana, interrupting the exercises at regular intervals to consume 480?mL of lukewarm saline. The solution was prepared by adding 9?g of sodium chloride per liter of lukewarm water (99°F-102°F/37.2°C-38.9°C). RESULTS: The mean total score was significantly better in Group A versus Group B (20.63?±?5.09 versus 16.48?±?5.18, p? J Altern Complement Med. 2010 Dec;16(12):1269-77. Arya V, Gupta KA, Arya SV. Weill Cornell Medical College and Endoscopy Unit, Wyckoff Heights Medical Center, Middle Village, NY, USA. varyamd@yahoo.com

FULL TITLE: Large ethnic variations in recommended physical activity according to activity domains in amsterdam, the netherlands.

PURPOSE: The level of recommended physical activity (PA) is met less frequently by people from some ethnic minorities than others. We explored whether these differences in recommended PA between ethnic minority groups and the general population varied by domain and type of culturally-specific activity. METHODS: Participants were sampled from the population based SUNSET study and were from ethnic Dutch (n = 567), Hindustani-Surinamese (n = 370) and African-Surinamese (n = 689) descent. The validated SQUASH-questionnaire measured PA for the following domains: commuting, occupation, household, leisure time. Culturally-specific activities were added as extra question within the leisure time domain. The effect of each domain on ethnic differences in recommended PA prevalence was examined by odds-ratio (OR) analysis through recalculating recommended PA, while, in turn, excluding the contribution of each domain. RESULTS: In the ethnic Dutch population, more vigorous PA in commuting and leisure time was reported compared to the Surinamese groups. The Hindustani-Surinamese and African-Surinamese reported more walking as commuting activity, while the Dutch group reported cycling more frequently. Ethnic differences in recommended PA became smaller in both Surinamese groups compared with the Dutch after removing commuting activity, for example, in Hindustani-Surinamese men (OR = 0.92, 95%CI: 0.62-1.37 vs. OR = 1.33, 0.89-2.00) and women (OR = 1.61, 1.12-2.32 vs. OR = 2.03, 1.41-2.92). Removing occupational activity resulted in larger ethnic differences in both groups compared with the Dutch. Smaller effects were found for yoga and dancing, leisure time and household activities. CONCLUSION: This study shows that differences in PA between ethnic minority groups and the general population vary according to the activity domain. The results indicate that including all relevant domains and activities is essential for assessment of ethnic differences in recommended PA.

Int J Behav Nutr Phys Act. 2010 Nov 29;7:85. de Munter JS, van Valkengoed IG, Agyemang C, Kunst AE, Stronks K. Academic Medical Center, Dept, of Public Health, University of Amsterdam, Amsterdam. j.s.demunter@amc.uva.nl.

FULL TITLE: Ethnic differences in complementary and alternative medicine use among patients with diabetes.

OBJECTIVE: To evaluate the effect of ethnicity as a predictor of the use of complementary and alternative medicine (CAM) among patients with diabetes. DESIGN AND SETTINGS: A 16-item questionnaire investigating CAM use was distributed among patients attending the Taking Control of Your Diabetes (TCOYD) educational conferences during 2004-2006. Six TCOYD were held across the United States. Information of diabetes status and sociodemographic data was collected. CAM use was identified as pharmacologic (herbs and vitamins) and nonpharmacologic CAMs (e.g., prayer, yoga, and acupuncture). RESULTS: The prevalence of pharmacologic and non-pharmacologic CAMs among 806 participants with diabetes patients was 81.9% and 80.3%, respectively. Overall, CAM prevalence was similar for Caucasians (94.2%), African Americans (95.5%), Hispanics (95.6%) and Native Americans (95.2%) and lower in Pacific Islanders/others (83.9%) and Asians (87.8%). Pharmacologic CAM prevalence was positively associated with education (p=0.001). The presence of diabetes was a powerful predictor of CAM use. Several significant ethnic differences were observed in specific forms of CAM use. Hispanics reported using frequently prickly pear (nopal) to complement their diabetes treatment while Caucasians more commonly used multivitamins. CONCLUSIONS: Treatment with CAM widely used in persons with diabetes. Ethnic group differences determine a variety of practices, reflecting groups' cultural preferences. Future research is needed to clarify the perceived reasons for CAM use among patients with diabetes in clinical practice and the health belief system associated with diabetes by ethnic group.

Complement Ther Med. 2010 Dec;18(6):241-8. Villa-Caballero L, Morello CM, Chynoweth ME, Prieto-Rosinol A, Polonsky WH, Palinkas LA, Edelman SV. Family and Preventative Medicine Department, School of Medicine, University of California, San Diego, CA, United States.

Although the use of yoga as a complementary therapy is common in palliative care, there is little evidence regarding current practice to inform service provision and research. The aim was to explore and compare yoga classes offered by palliative care services in New Delhi and London. Semi-structured qualitative interviews were conducted with yoga teachers and participants at two services and analysed thematically. Participants were: in Delhi eight family carers, three patients, and two teachers; in London six patients, one teacher, and one assistant. Six key themes are described: content of classes, symptoms and problems, preconceptions and the meaning of yoga, effects of yoga, challenges, and recommendations. This is the first study to examine the experiences of patients and carers practising yoga in palliative care settings. Recommendations include supporting and educating yoga teachers working with this population, and the need for robust trials.

Int J Palliat Nurs. 2010 Nov;16(11):548-54. Selman L, Higginson IJ. Department of Palliative Care, Policy and Rehabilitation, King's College London, London, United Kingdom. lucy.selman@kcl.ac.uk

Differences and points of contact between osteopathy and yoga as regards their history and practical application are outlined. Both seek to promote healing. Yoga seeks the attainment of consciousness; osteopathy aims for providing support to health. One fundamental difference is the personal involvement of the individual in yoga. Teacher and student alike are challenged to re-examine the attitudes of mind they have adopted toward their lives. Osteopathy generally involves a relatively passive patient while the osteopath is active in providing treatment. Practical examples are used to highlight points of contact between yoga and osteopathy. The text includes a discussion of the importance of physicality and a description of ways of using it in healing processes. Furthermore, processes of attaining consciousness are outlined. Possible reductionist misconceptions in yoga and osteopathy are also pointed out. Fundamental attitudes and focus that complement each other are presented, taking the concept of stillness as a particular example.

J Bodyw Mov Ther. 2011 Jan;15(1):92-102. Liem T. Osteopathie Schule Deutschland, Institute of Integrative Morphology, Frahmredder 16, 22393 Hamburg, Germany. tliem@osteopathie-schule.de

FULL TITLE: Impact of Relaxation Training According to Yoga in Daily Life(R) System on Perceived Stress After Breast Cancer Surgery.

The purpose of this pilot study was to gather information on the immediate and short-term effects of relaxation training according to Yoga In Daily Life(®) (YIDL) system on the psychological distress of breast cancer patients. 32 patients at the Institute for Oncology of Ljubljana were randomized to the experimental (N = 16) and to the control group (N = 16). Both groups received the same standard physiotherapy for 1 week, while the experimental group additionally received a group relaxation training sessions according to YIDL(®) system. At discharge the experimental group was issued with audiocassette recordings containing the similar instructions for relaxation training to be practiced individually at home (for further 3 weeks). An experimental repeated measures design was used to investigate the differences over 1 month period in stress levels, changes in mental health and psychological parameters. Measures were obtained at three time points during the study period: baseline, at 1 week, and at 4 weeks, by blinded investigators using standardized questionnaires General Health Questionnaire-12 (GHQ-12), Rotterdam Symptom Checklist (RSCL) psychological subscale, Perceived Stress Scale (PSS). Patients who received relaxation training reported feeling significantly less distressed during hospitalization and after discharge-period than did the controls that did not receive relaxation training. The results indicate that relaxation training according to Yoga in Daily Life(®) system could be useful clinical physiotherapy intervention for breast cancer patients experiencing psychological distress. Although this kind of relaxation training can be applied to clinical oncology in Slovenia, more studies need to be done.

Integr Cancer Ther. 2010 Dec 14. Kovacic T, Kovacic M. Centre for Education, Work and Care Dobrna.

FULL TITLE: Flexibility, functional autonomy and quality of life (QoL) in elderly yoga practitioners.

The aim of this study was to assess the levels of flexibility, functional autonomy and QoL in elderly yoga practitioners. The subjects were divided into a yoga group (YG; n=52; age=66.79±3.30 years; BMI=24.77±3.18) and control group (CG; n=31; age=69.33±4.84 years; BMI=24.32±3.71) and submitted to flexibility tests through goniometry, the LADEG autonomy protocol and QoL, using the WHOQOL-Old questionnaire. Repeated measures ANOVA showed increases in articular range of motion in shoulder abduction (?%SA=14.11%; p=0.0001), horizontal shoulder extension (?%HSE=33.90%; p=0.0001), lumbar spine flexion (?%LSF=50.74%; p=0.0001), hip flexion (?%HF=35.75%; p=0.0001), hip extension (?%HE=10.93%; p=0.021) and knee flexion (?%KF=3.90%; p=0.001) and in the GDLAM autonomy index (?%AI=-13.67%; p=0.0001) in the YG compared to the CG. The Mann-Whitney test revealed increases in QoL scores in Facet 1 (?%Fac1=9.04%; p=0.043), Facet 5 (?%Fac5=51.06%; p=0.0001) and in overall QoL (?%OqoL=8.13%; p=0.046) in the YG compared to the CG. The remaining variables showed no significant intergroup modifications. Thus, the study suggests that the regular practice of yoga may lead to improved range of motion in the performance of activities of daily living in elderly women.

Arch Gerontol Geriatr. 2010 Dec 15. Gonçalves LC, Vale RG, Barata NJ, Varejão RV, Dantas EH. Laboratory of Human Motricity Biosciences (LABIMH), Castelo Branco University (UCB), Av. Salvador Allende, n. 6700, Recreio do Bandeirantes, Rio de Janeiro, RJ, CEP 22780-160, Brazil.

AIM: The primary aim was to study the effect of naturopathy and yoga interventions in treatment of mild to moderate hypertension. DESIGN: The variables of interest were measured at the beginning and end of the intervention using a pre-post design. SETTING: The study was conducted by INYS medical research society in Jindal Nature Cure Institute, Bangalore. SUBJECTS: A total of 104 subjects, already diagnosed with mild to moderate hypertension and on treatment with antihypertensive medicines were included in study. INTERVENTIONS: The intervention consisted of various inpatient administration of different naturopathy treatments, yoga therapies, low calorie and low sodium diet for 21 days. Antihypertensive medicines were withdrawn for some patients in one week based upon response to the treatment. OUTCOME MEASURES: The outcome measures were values of diastolic and systolic blood pressure and body weight. Subjects were followed for a period of one year after every 3 months. RESULTS: After starting nonpharmacological approach of naturopathy and yoga, Systolic blood pressure came down from mean of 139.6 to 129.6 where as it came down from 91.2 to 86.1 for diastolic blood pressure. At the same time favorable effect was also seen in other variables like lipid profile and body weight. At the end of one year out of 57 patients who came for follow-up, 14 cases were found to have blood pressure within normal ranges without any medication over the previous 12 months. CONCLUSION: Naturopathy and yoga therapy can be considered as a valuable nonpharmacoloical approach in treatment of hypertension.

Complement Ther Clin Pract. 2011 Feb;17(1):9-12. Murthy SN, Rao NS, Nandkumar B, Kadam A. INYS Medical Research Society, Jindal Naturecure Institute, Jindal Nagar, Bangalore 560073, India.

FULL TITLE: Thinking through the body: the conceptualization of yoga as therapy for individuals with eating disorders.

Yoga has historically been viewed as a discipline that increases self-awareness through body based practices, meditation, self-study, and the reading of philosophical texts. In the 21st century the mindfulness techniques of yoga have been adapted as an adjunct to the treatment of individuals with eating disorders. In an effort to understand the conceptualization of yoga as therapy for individuals with eating disorders, this article juxtaposes how mindfulness based yoga is regarded in three disciplines: sociology, neuroscience, and the "spiritual texts" of yoga.

Eat Disord. 2011 Jan;19(1):83-96. Douglass L. Interdisciplinary Educational Studies Program, Lesley University, Cambridge, Massachusetts, USA.

Chronic pain can be a frustrating condition for patient and clinician. The integrative medicine approach to pain can offer hope, adding safe complementary and alternative medical (CAM) therapies to mitigate pain and suffering. Such CAM therapies include nutrition, supplements and herbs, manual medicine, acupuncture, yoga, and mind-body approaches. The evidence is heterogeneous regarding these approaches, but some evidence suggests efficacy and confirms safety. The integrative medicine approach can be beneficial in a patient with chronic pain.

Teets RY, Dahmer S, Scott E. Prim Care. 2010 Jun;37(2):407-21. Institute for Family Health, Beth Israel Residency in Urban Family Medicine, Department of Family and Social Medicine, Albert Einstein College of Medicine of Yeshiva University, 16 East 16th Street, New York, NY 10003, USA. rteets@institute2000.org

Full Title Effect of pranayama & yoga-asana on cognitive brain functions in type 2 diabetes-P3 event related evoked potential (ERP).

BACKGROUND & OBJECTIVES: Electrophysiological evidence of delayed cognition as measured by P300, an evoked potential is observed in Diabetes mellitus. P300 (or P3) is a component of endogenous cerebral evoked response that assesses higher functions of the brain. Our study aims to see the role of pranayama and yoga-asana on P300 latency and amplitude in type 2 diabetic patients.

METHODS: Sixty patients of type 2 diabetes were recruited from diabetic clinic and divided into two groups - control group on only conventional medical therapy and yoga-group on conventional medical therapy along with pranayama and yoga-asana. Basal recordings of P300 and blood glucose were taken at the time of recruitment and second recordings repeated after forty five days for both the groups. P300 was recorded on Nihon Kohden Neuropack mu MEB 9100 using auditory "odd-ball paradigm". The data were analysed using repeated measures analysis of variance (ANOVA) followed by Tukey's test at 5 per cent level of significance.

RESULTS: Statistically significant improvement in the latency and the amplitude of N200, P300 was observed in the yoga group as compared to the control group.

INTERPRETATION & CONCLUSION: Our data suggest that yoga has a beneficial effect on P300 and thus can be incorporated along with the conventional medical therapy for improving cognitive brain functions in diabetes.

Kyizom T, Singh S, Singh KP, Tandon OP, Kumar R. Indian J Med Res. 2010 May;131:636-40. Department of Physiology, University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi, India. tenkyiz5@yahoo.com

Background The use of complementary and alternative medicine (CAM) in paediatric populations is common yet, to date, there has been no synthesis of the evidence of its effectiveness in that population. This overview of systematic review evaluates the evidence for or against the effectiveness of CAM for any childhood condition. Methods Medline, AMED and Cochrane were searched from inception until September 2009. Reference lists of retrieved articles were hand-searched. Experts in the field of CAM were contacted. No language restrictions were applied. Results 17 systematic reviews were included in this overview, covering acupuncture, chiropractic, herbal medicine, homeopathy, hypnotherapy, massage and yoga. Results were unconvincing for most conditions although there is some evidence to suggest that acupuncture may be effective for postoperative nausea and vomiting, and that hypnotherapy may be effective in reducing procedure-related pain. Most of the reviews failed to mention the incidence of adverse effects of CAMs. Conclusions Although there is some encouraging evidence for hypnosis, herbal medicine and acupuncture, there is insufficient evidence to suggest that other CAMs are effective for the treatment of childhood conditions. Many of the systematic reviews included in this overview were of low quality, as were the randomised clinical trials within those reviews, further reducing the weight of that evidence. Future research in CAM for children should conform to the reporting standards outlined in the CONSORT and PRISMA guidelines.

Hunt K, Ernst E. Arch Dis Child. 2010 Jul 6. Complementary Medicine, Peninsula Medical School, Universities of Exeter and Plymouth, Exeter, UK.

Children with a cancer diagnosis experience symptom distress, including anxiety, because of the disease and its treatment. Parents experience stress and anxiety because of the uncertainty of the disease as well as the suffering of their children. Yoga is a complementary intervention that has physiological and psychological benefits in healthy children and healthy and chronically ill adults. On an inpatient hematology/oncology unit, 11 children aged 6 to 12 years, 5 adolescents aged 13 to 18 years, and 33 parents participated in a single yoga session tailored to the needs and abilities of the patients and parents. Sense of well-being pre- and postclass was measured with the Spielberger State Anxiety Scale. Children had normal anxiety scores preclass that did not change. Adolescents and parents experienced significant decreases in anxiety scores, and all cohorts gave positive feedback about the experience. The authors conclude that yoga is a feasible intervention for this population and is beneficial to adolescents and parents.

Thygeson MV, Hooke MC, Clapsaddle J, Robbins A, Moquist K. J Pediatr Oncol Nurs. 2010 Sep-Oct;27(5):276-84. Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA. megan.thygeson@childrensmn.org

Full Title Yoga and disc degenerative disease in cervical and lumbar spine: an MR imaging-based case control study.

The objective of the current study was to find out whether yoga practice was beneficial to the spine by comparing degenerative disc disease in the spines of long-time yoga practitioners and non-yoga practicing controls, using an objective measurement tool, magnetic resonance imaging. This matched case-control study comprised 18 yoga instructors with teaching experience of more than 10 years and 18 non-yoga practicing asymptomatic individuals randomly selected from a health checkup database. A validated grading scale was used to grade the condition of cervical and lumbar discs seen in magnetic resonance imaging of the spine, and the resulting data analyzed statistically. The mean number of years of yoga practice for the yoga group was 12.9 +/- 7.5. The overall (cervical + lumbar) disc scores of the yoga group were significantly lower (indicating less degenerative disc disease) than those of the control group (P < 0.001). The scores for the cervical vertebral discs of the yoga group were also significantly lower than those of the control group (P < 0.001), while the lower scores for the yoga group in the lumbar group approached, but did not reach, statistical significance (P = 0.055). The scores for individual discs of yoga practitioners showed significantly less degenerative disease at three disc levels, C3/C4, L2/L3 and L3/L4 (P < 0.05). Magnetic resonance imaging showed that the group of long-term practitioners of yoga studied had significantly less degenerative disc disease than a matched control group.

Jeng CM, Cheng TC, Kung CH, Hsu HC. Eur Spine J. 2010 Aug 15. Department of Radiology, Cathay General Hospital, No. 280, Jen-Ai Road Sec. 4, Taipei, 106, Taiwan, ROC, jengcm@cgh.org.tw.

Full Title State anxiety, psychological stress and positive well-being responses to yoga and aerobic exercise in people with schizophrenia: a pilot study.

Purpose. Worsening of schizophrenia symptoms is related to stress and anxiety. People with schizophrenia often experience difficulties in coping with stress and possess a limited repertoire of coping strategies. A randomised comparative trial was undertaken in patients with schizophrenia to evaluate changes in state anxiety, psychological stress and subjective well-being after single sessions of yoga and aerobic exercise compared with a control condition. Method. Forty participants performed a single 30-min yoga session, 20-min of aerobic exercise on a bicycle ergometre at self-selected intensity and a 20-min no exercise control condition in random order. Results. After single sessions of yoga and aerobic exercise individuals with schizophrenia or schizoaffective disorder showed significantly decreased state anxiety (p < 0.0001), decreased psychological stress (p < 0.0001) and increased subjective well-being (p < 0.0001) compared to a no exercise control condition. Effect sizes ranged from 0.82 for psychological stress after aerobic exercise to 1.01 for state anxiety after yoga. The magnitude of the changes did not differ significantly between yoga and aerobic exercise. Conclusion. People with schizophrenia and physiotherapists can choose either yoga or aerobic exercise in reducing acute stress and anxiety taking into account the personal preference of each individual.

Vancampfort D, De Hert M, Knapen J, Wampers M, Demunter H, Deckx S, Maurissen K, Probst M. Disabil Rehabil. 2010 Aug 18. Faculty of Kinesiology and Rehabilitation Sciences.

We interviewed 300 patients (54.7% male; mean age was 65.8 +/- 9.5) attending the Movement Disorders Clinic at the Buenos Aires University Hospital to determine the prevalence of CATs use and their association with demographic, social, or disease-specific characteristics among patients with Parkinson's disease (PD) in Buenos Aires, Argentina. We found that 25.7% of the PD patients interviewed (77/300) stated they had used CATs to improve their PD symptoms whereas 38.0% (114/300) had used some CATs without any relation to PD, at least once in life. At the moment of the interview, CATs prevalence use was 50.6% in the former group and 25.0% in the latter. The use of CATs was much more frequent among women and more common in the 50- to 69-year age group. Friends and neighbors of the patients had most frequently recommended these therapies. No major association was observed between CATs use and the duration of the disease, side of initial involvement, PD phenotype, or the Hoehn and Yahr staging. Acupuncture, homeopathy, yoga, and therapeutic massage were the most widely used therapies. After the initiation of conventional treatment the use of massage, yoga, and acupuncture in patients using CATs to improve PD significantly increased. Neurologists should be aware and inquire about the use of CATs to rule out potentially harmful effects. (c) 2010 Movement Disorder Society.

Pecci C, Rivas MJ, Moretti CM, Raina G, Ramirez CZ, Díaz S, Uribe Roca C, Micheli FE. Mov Disord. 2010 Aug 18. Parkinson's Disease and Movement Disorders Unit, Hospital de Clínicas "José de San Martín," Universidad de Buenos Aires, Argentina.

Full Title Effects of Yoga Versus Walking on Mood, Anxiety, and Brain GABA Levels: A Randomized Controlled MRS Study.

Abstract Objectives: Yoga and exercise have beneficial effects on mood and anxiety. gamma-Aminobutyric acid (GABA)-ergic activity is reduced in mood and anxiety disorders. The practice of yoga postures is associated with increased brain GABA levels. This study addresses the question of whether changes in mood, anxiety, and GABA levels are specific to yoga or related to physical activity. Methods: Healthy subjects with no significant medical/psychiatric disorders were randomized to yoga or a metabolically matched walking intervention for 60 minutes 3 times a week for 12 weeks. Mood and anxiety scales were taken at weeks 0, 4, 8, 12, and before each magnetic resonance spectroscopy scan. Scan 1 was at baseline. Scan 2, obtained after the 12-week intervention, was followed by a 60-minute yoga or walking intervention, which was immediately followed by Scan 3. Results: The yoga subjects (n = 19) reported greater improvement in mood and greater decreases in anxiety than the walking group (n = 15). There were positive correlations between improved mood and decreased anxiety and thalamic GABA levels. The yoga group had positive correlations between changes in mood scales and changes in GABA levels. Conclusions: The 12-week yoga intervention was associated with greater improvements in mood and anxiety than a metabolically matched walking exercise. This is the first study to demonstrate that increased thalamic GABA levels are associated with improved mood and decreased anxiety. It is also the first time that a behavioral intervention (i.e., yoga postures) has been associated with a positive correlation between acute increases in thalamic GABA levels and improvements in mood and anxiety scales. Given that pharmacologic agents that increase the activity of the GABA system are prescribed to improve mood and decrease anxiety, the reported correlations are in the expected direction. The possible role of GABA in mediating the beneficial effects of yoga on mood and anxiety warrants further study.

Streeter CC, Whitfield TH, Owen L, Rein T, Karri SK, Yakhkind A, Perlmutter R, Prescot A, Renshaw PF, Ciraulo DA, Jensen JE. J Altern Complement Med. 2010 Aug 19. 1 Division of Psychiatry, Boston University School of Medicine , Boston, MA.

BACKGROUND: Complementary therapies such as yoga practice have become commonplace, yet the safety, physical, and psychological effects on patients with heart failure (HF) are unknown. The purpose of this study was to determine whether an 8-week yoga program was safe and would positively influence physical and psychological function in HF patients.

METHODS AND RESULTS: Stable HF patients were recruited (n = 15) and completed (n = 12) 8 weeks of yoga classes. Data collected were: safety (cardiac and orthopedic adverse events); physical function (strength, balance, endurance, flexibility); and psychological function (quality of life [QOL], depression scores, mindfulness) before and after 8 weeks of yoga classes.

RESULTS: Mean age was 52.4 + or - 11.6 with three-fourths (n = 9) being male and Caucasian. No participant had any adverse events. Endurance (P < .02) and strength (upper P = .04 and lower body P = .01) significantly improved. Balance improved by 13.6 seconds (26.9 + or - 19.7 to 40.0 + or - 18.5; P = .05). Symptom stability, a subscale of QOL, improved significantly (P = .02). Although no subject was depressed, overall mood was improved. Subjects subjectively reported improvements in overall well-being.

CONCLUSIONS: Yoga practice was safe, with participants experiencing improved physical function and symptom stability. Larger studies are warranted to provide more nonpharmacological options for improved outcomes in patients with HF.

Howie-Esquivel J, Lee J, Collier G, Mehling W, Fleischmann K. J Card Fail. 2010 Sep;16(9):742-9. Department of Physiological Nursing, University of California, San Francisco, CA, USA. jill.howie-esquivel@nursing.ucsf.edu

Yes. Exercise reduces patient-perceived symptoms of depression when used as monotherapy (strength of recommendation [SOR]: B, meta-analysis of randomized controlled trials [RCTs] with significant heterogeneity). It relieves symptoms as effectively as cognitive behavioral therapy (CBT) or pharmacologic anti-depressant therapy (SOR: B, meta-analysis) and more effectively than bright light therapy (SOR: B, meta-analysis). Resistance exercise and mixed exercise (resistance and aerobic) work better than aerobic exercise alone (SOR: B, meta-analysis). High-frequency exercise is more effective than low-frequency exercise (SOR: B, small RCT). "Mindful" exercise, which has a meditative focus, such as tai chi and yoga, also reduces symptoms of depression (SOR: B, systematic review of RCTs).

Gill A, Womack R, Safranek S. J Fam Pract. 2010 Sep;59(9):530-1. Tacoma Family Medicine Residency Program, University of Washington Department of Family Medicine, Tacoma, WA, USA.

BACKGROUND:: With continual improvements in screening uptake and adjuvant cancer treatments, the number of Canadian women surviving breast cancer continues to grow. Preliminary findings suggest yoga can improve quality of life (QoL) in breast cancer survivors, but few studies have focused on Iyengar yoga (IY). OBJECTIVE:: The purpose of this pilot study was to evaluate the impact of IY on QoL and psychosocial functioning in a select sample of breast cancer survivors. METHODS:: Breast cancer survivors (N = 24) participating in IY classes completed a questionnaire measuring generic and disease-specific QoL and psychosocial functioning, before and after the 12-week classes. RESULTS:: Postprogram questionnaires were completed by 17 participants (71%) who attended an average of 78.9% of the IY sessions. Several indicators of generic QoL improved significantly, including mental health (mean change, +4.2; P = .045), vitality (mean change, +4.9; P = .033), role-emotional (mean change, +6.4; P = .010), and bodily pain (mean change, +4.4; P = .024). Other improvements in QoL and psychosocial functioning were meaningful but were not statistically significant. Findings were further substantiated by participant's evaluation of the program's benefits and motivational value. CONCLUSION:: In this pilot study of breast cancer survivors participating in IY, we found improvements in QoL and psychosocial functioning. Moreover, positive program evaluation and motivational profile provide support for the acceptability of IY with breast cancer survivors. Randomized controlled trials comparing IY to usual care and other forms of yoga in breast cancer survivors are warranted. IMPLICATIONS FOR PRACTICE:: Nurses may consider IY as a possible intervention strategy to help breast cancer survivors improve their QoL and psychosocial functioning.

Cancer Nurs. 2010 May 12.Speed-Andrews AE, Stevinson C, Belanger LJ, Mirus JJ, Courneya KS. Author Affiliations: Faculty of Physical Education and Recreation, University of Alberta (Dr Speed-Andrews, Ms Belanger, and Dr Courneya), Edmonton, Canada; School of Sport, Exercise and Health Sciences, University of Loughborough, United Kingdom (Dr Stevinson); and Iyengar Yoga Association of Canada (Ms Mirus), Edmonton AB, Canada.

CONTEXT: Rheumatoid arthritis (RA) is a chronic disease that often impacts patient's quality of life. For young people with RA, there is a need for rehabilitative approaches that have been shown to be safe and to lead to improved functioning. OBJECTIVES: This pilot study investigated the feasibility of a single-arm, group-administered, six-week, biweekly Iyengar yoga (IY) program for eight young adults with RA. METHODS: IY is known for its use of props, therapeutic sequences designed for patient populations, emphasis on alignment, and a rigorous teacher training. Treatment outcomes were evaluated using a mixed-methods approach that combined quantitative results from standardized questionnaires and qualitative interviews with participants. RESULTS: Initial attrition was 37% (n=3) after the first week because of scheduling conflicts and a prior non-RA related injury. However, the remaining participants (n=5) completed between 75% and 100% of treatment sessions (mean=95%). No adverse events were reported. The quantitative results indicated significant improvements in pain, pain disability, depression, mental health, vitality, and self-efficacy. Interviews demonstrated improvement in RA symptoms and functioning but uncertainty about whether the intervention affected pain. CONCLUSION: These preliminary findings indicate that IY is a feasible complementary approach for young people with RA, although larger clinical trials are needed to demonstrate safety and efficacy. Copyright 2010 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

J Pain Symptom Manage. 2010 May;39(5):904-13.Evans S, Moieni M, Taub R, Subramanian SK, Tsao JC,

Sternlieb B, Zeltzer LK. Pediatric Pain Program, David Geffen School of Medicine, University of California, Los Angeles, California 90024, USA. suevans@mednet.ucla.edu

Full Title: Yoga as a complementary treatment for smoking cessation: rationale, study design and participant characteristics of the Quitting-in-Balance study

BACKGROUND: Tobacco smoking remains the leading preventable cause of death among American women. Exercise has shown promise as an aid to smoking cessation because it reduces weight gain and weight concerns, improves affect, and reduces nicotine withdrawal symptoms and cigarette craving. Studies have shown that the practice of yoga improves weight control, and reduces perceived stress and negative affect. Yoga practice also includes regulation of breathing and focused attention, both of which may enhance stress reduction and improve mood and well-being and may improve cessation outcomes. METHODS/DESIGN: This pilot efficacy study is designed to examine the rates of cessation among women randomized to either a novel, 8-week Yoga plus Cognitive Behavioral Therapy (CBT) smoking cessation intervention versus a Wellness program plus the same CBT smoking cessation intervention. Outcome measures include 7-day point prevalence abstinence at end of treatment, 3 and 6 months follow up and potential mediating variables (e.g., confidence in quitting smoking, self-efficacy). Other assessments include measures of mindfulness, spirituality, depressive symptoms, anxiety and perceived health (SF-36). DISCUSSION: Innovative treatments are needed that address barriers to successful smoking cessation among men and women. The design chosen for this study will allow us to explore potential mediators of intervention efficacy so that we may better understand the mechanism(s) by which yoga may act as an effective complementary treatment for smoking cessation. If shown to be effective, yoga can offer an alternative to traditional exercise for reducing negative symptoms that often accompany smoking cessation and predict relapse to smoking among recent quitters. TRIAL REGISTRATION: ClinicalTrials NCT00492310.

BMC Complement Altern Med. 2010 Apr 29;10:14. Bock BC, Morrow KM, Becker BM, Williams DM, Tremont G, Gaskins RB, Jennings E, Fava J, Marcus BH. Centers for Behavioral and Preventive Medicine, Alpert School of Medicine at Brown University, The Miriam Hospital, Providence, RI 02903, USA. Bbock@lifespan.org

Full Title: "Overeating is Not About the Food": Women Describe Their Experience of a Yoga Treatment Program for Binge Eating

As part of a larger mixed-methods study, data from 20 personal journals were analyzed to examine the experience of a 12-week yoga treatment program for binge eating among a sample of 25 women who were obese. Qualitative analysis revealed a positive shift experienced by the women during the program, summarized by a general structural description: disconnection versus connection. Women's comments suggested that the program appeared to encourage a healthy reconnection to food, as well as the development of physical self-empowerment, through cultivating present-moment awareness. Specifically, women perceived an overall reduction in the quantity of food they consumed, decreased eating speed, and an improvement in food choices throughout the program. The women also reported feeling more connected to and positive about their physical well-being. These evolving outcomes were summarized through two major themes: the way their physicality changed, and the way their food consumption changed over time. Findings provide insights relevant to therapeutic processes that might occur within eating disorder interventions that draw on meditation-based approaches.

Qual Health Res. 2009 Sep;19(9):1234-45. McIver S, McGartland M, O'Halloran P. Deakin University, Melbourne, Victoria, Australia.

ABSTRACT: BACKGROUND: A yoga practice involving cycles of yoga postures and supine rest (called cyclic meditation) was previously shown to improve performance in attention tasks more than relaxation in the corpse posture (shavasana). This was ascribed to reduced anxiety, though this was not assessed. METHODS: In fifty-seven male volunteers (group average age +/- S.D., 26.6 +/- 4.5 years) the immediate effect of two yoga relaxation techniques was studied on memory and state anxiety. All participants were assessed before and after (i) Cyclic meditation (CM) practiced for 22:30 minutes on one day and (ii) an equal duration of Supine rest (SR) or the corpse posture (shavasana), on another day. Sections of the Wechsler memory scale (WMS) were used to assess; (i) attention and concentration (digit span forward and backward), and (ii) associate learning. State anxiety was assessed using Spielberger's State-Trait Anxiety Inventory (STAI). RESULTS: There was a significant improvement in the scores of all sections of the WMS studied after both CM and SR, but, the magnitude of change was more after CM compared to after SR. The state anxiety scores decreased after both CM and SR, with a greater magnitude of decrease after CM. There was no correlation between percentage change in memory scores and state anxiety for either session. CONCLUSION: A cyclical combination of yoga postures and supine rest in CM improved memory scores immediately after the practice and decreased state anxiety more than rest in a classical yoga relaxation posture (shavasana).

Biopsychosoc Med. 2009 Aug 13;3(1):8. Subramanya P, Telles S.

Yoga and meditation can alleviate stress, anxiety, mood disturbance, and musculoskeletal problems, and can enhance cognitive and physical performance. Professional musicians experience high levels of stress, performance anxiety, and debilitating performance-related musculoskeletal disorders (PRMDs). The goal of this controlled study was to evaluate the benefits of yoga and meditation for musicians. Young adult professional musicians who volunteered to participate in a 2-month program of yoga and meditation were randomized to a yoga lifestyle intervention group (n = 15) or to a group practicing yoga and meditation only (n = 15). Additional musicians were recruited to a no-practice control group (n = 15). Both yoga groups attended three Kripalu Yoga or meditation classes each week. The yoga lifestyle group also experienced weekly group practice and discussion sessions as part of their more immersive treatment. All participants completed baseline and end-program self-report questionnaires that evaluated music performance anxiety, mood, PRMDs, perceived stress, and sleep quality; many participants later completed a 1-year followup assessment using the same questionnaires. Both yoga groups showed a trend towards less music performance anxiety and significantly less general anxiety/tension, depression, and anger at end-program relative to controls, but showed no changes in PRMDs, stress, or sleep. Similar results in the two yoga groups, despite psychosocial differences in their interventions, suggest that the yoga and meditation techniques themselves may have mediated the improvements. Our results suggest that yoga and meditation techniques can reduce performance anxiety and mood disturbance in young professional musicians.

Appl Psychophysiol Biofeedback. 2009 Aug 6. Khalsa SB, Shorter SM, Cope S, Wyshak G, Sklar E. Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA, khalsa@hms.harvard.edu.

Yoga represents a fascinating mind-body approach, wherein body movements (asana), breathing exercises (pranayama) and meditation are integrated into a single multidimensional practice. Numerous beneficial mental and physical effects have been classically ascribed to this holistic ancient method. The purpose of the present study has been to examine the effects of long-term yoga practice on Subjective Sleep Quality (SSQ) and on several hormonal parameters of the hypothalamus-pituitary-adrenal (HPA) axis. Twenty-six subjects (16 experimental and 10 controls) were recruited to be part of the study. Experimental subjects were regular yoga practitioners with a minimum of 3 years of practice. Blood samples for the quantification of adrenocorticotropic hormone (ACTH), cortisol and dehydroepiandrosterone sulphate (DHEA-S) were drawn from all subjects. Likewise, the Pittsburgh Sleep Quality Index (PSQI) was employed to assess SSQ. As statistical analysis, Mann-Whitney U-test was performed. The yoga group displayed lower PSQI scores and higher blood cortisol levels than control subjects. Therefore, it can be concluded that long-term yoga practice is associated with significant psycho-biological differences, including better sleep quality as well as a modulatory action on the levels of cortisol. These preliminary results suggest interesting clinical implications which should be further researched.

Biol Psychol. 2009 Jul;81(3):164-8. Epub 2009 Apr 1. Vera FM, Manzaneque JM, Maldonado EF, Carranque GA, Rodriguez FM, Blanca MJ, Morell M. Department of Psychobiology and Methodology, Faculty of Psychology, University of Malaga, Campus de Teatinos, Malaga, Spain. pvera@uma.es

by Adele Ryan McDowell, PhD

Ever have one of those days? You are brimming with newly found motivation and re-aligned resolution. You haven't even walked out of the door, yet, and the thought of what you are going to accomplish has you filled with button-bursting pride. You are puffed up with purpose. You are ready to course correct. Today is the first day of the rest of your life.

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