1. Comparing Yoga, Exercise, and a Self-Care Book for Chronic Low Back Pain: A Randomized, Controlled Trial

Source: Annals of Internal Medicine, 143, 849-856.

Authors: Sherman, K.J., Cherkin, D.C., Erro, J., Miglioretti, D.L., & Deyo, R.A.

Contact: Karen Sherman, Group Health Cooperative and University of Washington, Sherman.k@ghc.org.

This randomized controlled trial compared the benefits of Yoga, conventional therapeutic exercise, and a self-care book for chronic low back pain.

Participants: 101 adults (66 women, mean age of 44) with chronic low back pain, the majority of whom had experienced pain for longer than one year, and had experienced pain for more than 45 of the past 90 days prior to entering the study.

Interventions: Participants were randomly assigned to either a 12-week Yoga intervention, a 12-week exercise intervention, or a home study/educational book intervention. IAYT Advisors Gary Kraftsow and Robin Rothenberg designed the 75-minute group classes and home practice guides for participants. The classes followed a gentle Viniyoga approach specifically designed for back pain. Each class had a specific focus (such as relaxation, strengthening the hip muscles, or customizing a personal practice), and included a question-and-answer period, an opening and closing breathing exercise, 5 to 12 postures, and a guided deep relaxation. Postures were repeated rather than held, and included: cobra, bridge, knees to chest, reclining leg stretches and hip openers, modifications of warrior and chair, standing forward bend, and kneeling forward bend (child’s pose). The therapeutic exercise intervention was designed by a physical therapist, and included education about biomechanics and both aerobic and strength-building exercise. The self-care book was The Back Pain Helpbook by J. Moore et al., an evidence-based book that teaches a comprehensive fitness and strength program, lifestyle changes, and guidelines for managing pain.

     Results: Participants in the Yoga group showed the greatest improvements in back function at 12 weeks (the end of the intervention). At 26 weeks, the Yoga group also showed greater improvements in symptoms/less use of pain medication than the other two groups. At 26 weeks, the Yoga group and therapeutic exercise group showed similar improvements in back function, and both groups showed greater improvements than the education book group.

     An educational handout summarizing this study was written for the public and is available at:

     Note: An interview with author Karen Sherman and Yoga teacher Robin Rothenberg, discussing the Yoga program used in this study and the challenges of running the study, was published in the 2005 International Journal of Yoga Therapy.

Source: Alternative Therapies in Health and Medicine, 12, 40-47.

Authors: Moolasarn, S., Sripa, S., Kuessirikiet, V., Sutawee, K., Huasary, J., Chaisila, C., Chechom, N., & Sankan, S.

Contact: Department of Neurology and Behavioral Neuroscience, Oregon Health and Science University, Portland, OR, USA.

www.ohsu.edu

This randomized, controlled trial compared the benefits of six months of Yoga, walking, and a wait-list control for 118 generally healthy seniors (65-85 years). The Yoga and walking conditions included both group classes and a recommendation of home practice. Neither Yoga nor walking improved cognitive function (including a an EEG measure of alertness). Participants in the Yoga condition showed improvements in physical outcomes such as balance and flexibility, and quality-of-life outcomes such as energy and sense of well-being.

A Discussion and Critical Review

Authors: Ott, M.J., Norris, R.L., & Bauer-Wu, S.M.

Source: Integrative Cancer Therapies, 5, 98-108.

Contact: Mary Jane Ott, Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA, 02115.

maryjane_ott@dfci.harvard.edu

This article reviews the existing and emerging research on mindfulness meditation as an intervention for cancer  patients. The authors describe the rationale for teaching mindfulness meditation to cancer patients as follows:

“Mindfulness meditation can be helpful to cancer patients across the continuum of care from diagnosis through procedures, treatments, cure, and survival, as well as at the end of life. It is a useful skill that can be practiced by patients to reduce and cope with stress, promote relaxation, and alleviate physical discomfort and emotional distress.”

Mindfulness practices commonly taught include sitting meditation, awareness of sensations, the body scan (a breath visualization practice), and mindful movement (typically gentle Yoga or walking meditation). The authors’ search for studies published between 1987 and 2004 identified 9 research articles and 5 conference  abstracts. [Note: A search on PubMed in May 2006 identified only one additional study of mindfulness for cancer patients; it demonstrated benefits for sleep quality, energy levels, and mood.]

The majority of studies focused on group mindfulness classes for breast and prostate cancer patients. The studies consistently reported positive effects on psychological well-being, as well as reductions in physical symptoms. The authors also found limited/mixed evidence for the benefits of mindfulness interventions on nutritional outcomes—namely, adopting a lower-fat and lower-calorie, plant-based diet, and reducing caffeine intake. Evidence for immunological and neuroendocrine effects were much more limited, mostly due to a lack of published research. The few published studies provide promising evidence that mindfulness may have an anti-inflammatory effect, and may influence the physiological stress response, but there is not enough evidence to make strong claims.

Source: Nepal Medical College Journal, 7, 145-147.

Authors: Malhotra, V., Singh, S., Tandon, O.P., & Sharma, S.B.

Contact: Varun Malhotra, Department of Physiology, University College of Medical Sciences and Guru Tegh Bahadur Hospital, Delhi. P.O. Box 155, MCOMS, Pokhara, Nepal. dr_varun@yahoo.com.

This study investigated the benefits of Yoga asana for 20 participants (between the ages of 30 and 60) with mild to moderate non-insulin dependent diabetes. in All participants were on diet and medication for the control of diabetes. The study also compared the Yoga group to a control group of 36 adults, also following a diet and medication plan to control diabetes, that practiced standard exercise guidelines for diabetes (such as walking).

Participants in the Yoga group practiced Yoga for 30-40 minutes every morning for 40 days. The asana practice included: surya namaskar, bhastrika pranayama, trikonasana, tadasana, sukhasana, padmasana, pashimottanasana, ardha matsyendrasana, pawanmuktasana, bhujangasana, vajrasana, dhanurasana, and savasana.

Yoga participants showed the following changes after the 40-day program: reduced waist to hip ratio (high waist to hip ratio is considered a risk factor for cardiovascular and metabolic disease) and a decrease in fasting blood glucose. There was also a marginally significant trend for reductions in postprandial (after-meal) blood glucose levels. Among obese participants (but not participants of lower weight), serum levels of insulin decreased. All of these changes are considered positive for the management of diabetes. The control group showed no positive changes in any of these measurements. The authors conclude that Yoga “may be used as an adjunct with diet and drugs in the management of Type 2 diabetes.”

5. Feasibility and Acceptability of Restorative Yoga for Treatment of Hot Flushes: A Pilot Trial

Source: Maturitas. Published online (September 2006).

Authors: Cohen, B.E., Kanaya, A.M., Macer, J.L., Shen, H., Chang, A.A., & Grady, D.

Contact: Beth E. Cohen, San Francisco VA Medical Center, General Internal Medicine Section (111A1), 4150 Clement Street, San Francisco, CA, 94121, United States. Beth.Cohen@ucsf.edu.

Researchers at the San Francisco Veterans Affairs Medical Center and the University of California, San Francisco, conducted a pilot study of restorative Yoga for the treatment of hot flushes in postmenopausal women. Fourteen postmenopausal women (mean age 58) experiencing moderate to severe hot flushes participated in an 8-week Yoga intervention designed and taught by two certified Yoga instructors with “extensive experience working with peri- and postmenopausal women.”

Participants first attended a 3-hour workshop that introduced eight postures: balasana (child’s pose), adho mukha svanasana (downward facing dog), baddha konasana (seated bound angle pose), upavistha konasana (seatedwide angle pose), viparita karani (supported legs up the wall), setu bandha sarvangasana (supported bridge pose), supta baddha konasana (supported lying down bound angle pose) and savasana (corpse pose). The women then attended eight weekly 90-minute Yoga classes and were asked to practice at home for 1 hour at least three times per week.

It is interesting to note that this study was reported as a feasibility and acceptability study, meaning that one of the primary goals of the study was to establish that a Yoga intervention could successfully recruit and retain postmenopausal women. The researchers report 93% retention of participants, 92% of whom attended at least 7 of the 8 sessions. Participants practiced at home for an average of 170 minutes per week. At a 3-month follow-up, 75% of participants reported continuing to practice the Yoga poses they had learned in the intervention; 44% went on to learn new poses. As part of the acceptability study, researchers also asked participants what was “the most bothersome part of the study.” The most common response was “taking time to practice Yoga at home” (38.5%). Participants suggested that home practice guides, such as a video or handouts, would improve the intervention.

     The study also reports that the participants experienced on average a 31% reduction in hot flush frequency and a 34% reduction in hot flush severity, from baseline to week 8. The authors discuss one possible mechanism for how restorative Yoga can help menopausal symptoms: reduction in sympathetic activation, which can contribute to hot flushes. Although this study did not measure changes in sympathetic activation, the authors cite other studies that have demonstrated changes following Yoga practice.

6. Yoga Asana Sessions Increase Brain GABA Levels: A Pilot Study.

Source: Journal of Alternative and Complementary Medicine, 13, 419-26. May 2007.

Authors: Streeter, C.C., Jensen, J.E., Perlmutter, R.M., Cabral, H.J., Tian, H., Terhune, D.B.,  Ciraulo, D.A., & Renshaw, P.F.

Contact: Chris C. Streeter, Division of Psychiatry, Boston University School of Medicine, Boston, MA, 02118. streeter@bu.edu.

This study examined how a 60-minute Yoga asana practice altered practitioners’ levels of the neurotransmitter gamma-aminobutyric (GABA). The researchers were interested in Yoga’s potential effects on GABA because low levels of GABA are associated with both depression and anxiety. Researchers recruited individuals with an established Yoga practice (n = 8), who practiced self-guided asana in the style of their regular practice for 60 minutes, and control participants (n = 11), who read for 60 minutes. Researchers used magnetic resonance spectroscopic imaging of the brain to measure GABA levels in all participants immediately before and after their 60-minute sessions. Reading had no significant effect on GABA levels; however, Yoga practitioners showed a 27% increase in GABA levels following asana practice.

This is an important study for two reasons. First, the Yoga practitioners were not all practicing within the same tradition, and yet the results were similar for ashtanga vinyasa, Bikram, and Kripalu-influenced practices. This lends greater credence to the idea that many of Yoga’s benefits are not unique to specific practices, sequences, or lineages. The study is also important because it begins to address the question of mechanism: if Yoga helps people deal with anxiety and depression, how does it work? It could be argued that these brain changes are the outcome of psychological and spiritual changes that occur during the practice (and not necessarily the cause of them). However, in a culture that considers psychotropic drugs as a first choice, evidence that Yoga has a similar effect may encourage many to consider it an alternative or complementary therapy.

Source: European Journal of Cancer Care, 16, 462-74. November 2007.

Authors: Raghavendra, R.M., Nagarathna, R., Nagendra, H.R., Gopinath, K.S., Srinath, B.S., Ravi, B.D., Patil, S., Ramesh, B.S., & Nalini, R.

Contact: Department of Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana, Bangalore, India.

This randomized controlled trial, conducted by the same research group as the study described above, compared the effects of an integrated Yoga intervention versus standard supportive therapy for women receiving chemotherapy for breast cancer. The Yoga intervention (n = 28) consisted of both supervised and home practice, and participants in the Yoga group were instructed to practice for 60 minutes every day. The control group (n = 34) received the standard supportive therapy offered at the hospital providing chemotherapy.

Researchers were primarily interested in how the two programs would affect one of the most common side effects of chemotherapy, nausea and emesis. Researchers also measured psychological well-being and quality of life. Compared to the supportive care control group, the Yoga group showed significant lower post-chemotherapy-induced nausea frequency and intensity, as well as intensity of anticipatory nausea and anticipatory vomiting. There were no significant differences for the psychological variables. This study suggests that a Yoga practice can reduce some of the side effects associated with chemotherapy.

8. Yoga for Women with Metastatic Breast Cancer: Results from a Pilot Study

Source: Journal of Pain Symptom Management, 33, 331-341.

Authors: Carson, J.W., Carson,K.M., Porter, L.S., Keefe, F.J., Shaw, H., & Miller, J.M.

Contact: James W. Carson, Pain Prevention & Treatment Research Program, Department of Psychiatry, Duke University Medical Center,Box 90399, Durham, NC, 27708. jim.carson@duke.edu.

The pilot study examined the benefits of the Yoga of Awareness Program for 13 women with metastatic breast cancer. The participants had a mean age of 59 years (range 44-75). Seven women were receiving chemotherapy during the intervention, and all continued with standard medical care. The authors anticipated that Yoga would promote three therapeutic processes (invigoration, acceptance, and relaxation) that are particularly relevant to coping with metastatic cancer.

   The eight-week Yoga program (one two-hour session per week) was specifically designed for women with metastatic breast cancer. Each session included breath awareness meditation, gentle asanas (e.g., seated forward bend and supine spine twist), pranayama (e.g., extended exhalation and breathing into sensation), meditation techniques, lectures on applying Yoga philosophy to everyday life and cancer symptoms (e.g., acceptance during intervals of pain) and group discussions about both Yoga and the women's experiences with cancer. To support home practice between weekly sessions, participants were given a Yoga mat, a blanket, audio instructions, and illustrated guidebooks. The sessions were jointly led by a certified Yoga teacher and a clinical health psychologist.

   A strength of this pilot study was the use of daily diaries to record Yoga practice and its outcomes for two weeks before the Yoga program began, and during the last two weeks of the eight-week program. Participants completed evening diary reports on their Yoga practice and their daily experience of pain, fatigue, distress, invigoration, acceptance, and relaxation.

   Participants report practicing for an average of 21 minutes each day. Analyses showed that the day after a Yoga practice, women experienced significantly less pain and fatigue and significantly higher levels of invigoration, acceptance, and relaxation. When the daily reports were combined to test the overall effects of the intervention, there was a significant pre-to-post improvement in invigoration and acceptance.

   The participants also completed a focus group at the end of the intervention. Their feedback focused on the stress-reduction benefits of the practice and the social support provided by interacting with a group of other women with metastatic breast cancer. Participants attended an average of seven of the eight sessions, demonstrating the feasibility of the program for women with metastatic breast cancer. All participants said they would recommend the program to other women. 

Source: Alternative Therapies in Health and Medicine, 13(1), 38-44. Jan-Feb 2007.

Authors: Lane, J.D., Seskevich, J.E., & Pieper, C.F.

Contact: Department of Psychiatry, Duke University Medical Center in Durham, NC. jdlane@duke.edu.

The authors designed a brief meditation intervention designed to be non-sectarian, inexpensive, and easy to implement in a wide range of contexts, including medical settings. 200 participants were recruited for a "Calm Your Stress Study." Participants were instructed to choose a sound, word, or brief phrase as a mantra, and to mentally repeat the mantra for 15-20 minutes. Participants were instructed to notice any thoughts or sensations that distracted their attention from the mantra, and return their focus to the mantra. This study was, in many ways, a test of how little instruction is needed to produce benefits. Participants learned the practice in a one-hour session and were instructed to practice twice daily for three months. Thee follow-up sessions were held over the first two weeks of the study to reinforce instructions and answer questions. Participants completed self-report measures of mood, anxiety, stress, and psychological symptoms before the first session and at three follow-up timepoints (4 weeks, 8 weeks, and 12 weeks).

   133 of the original 200 participants (101 women and 32 men; mean age of 38 years) completed at least one of the follow-ups. Participants showed significant decreases in negative mood, anxiety, stress, and psychological symptoms. These improvements were evident at the first follow-up and stable over the remaining follow-ups. Importantly, participants who practiced the meditation more frequently (daily) showed the greatest improvements. A secondary finding of interest is that participants with high levels of neuroticism (a personality trait related to emotional reactivity and negative moods) were particularly likely to benefit from the meditation training.

10. Mindfulness Meditation Alleviates Depressive Symptoms in Women with Fibromyalgia: Results of a Randomized Clinical Trial.

Source: Arthritis and Rheumatism, 57(1), 77-85.

Authors: Sephton, S.E., Salmon, P., Weissbecker, I., Ulmer, C., Floyd, A., Hoover, K., & Studts, J.L.,

Contact: Sandra Sephton, sephton@louisville.edu

 

The authors present a randomized controlled trial that examined the effects of a standard 8-week Mindfulness-Based Stress Reduction (MBSR) intervention on depression among women with fibromyalgia, a chronic and often debilitating pain and fatigue disorder.  91 women (mean age of 48 years) were randomly assigned to either the MBSR intervention (2 groups of 25 women each) or a wait-list control group (41 women). Participants in the MBSR group attended weekly 2.5 hour sessions, led bya licensed clinical psychologist, that included practice and discussion. The authors describe the MBSR program as follows: "MBSR utilizes stress-reduction skills including sitting meditation, hatha yoga, and a somatically focused technique called the Body Scan. Participants are encouraged to maintain attention on their immediate experience with an attitude of openness, acceptance, curiosity, and compassion." As is typical with MBSR interventions, participants were encouraged to practice at home daily.  Researchers compared the effects of MBSR versus standard medical care (the wait-list control group) at immediately following the 8-week intervention, and at an additional 2-month follow-up. At both time points, the MBSR group showed significant improvements in depression compared to the control group (the MBSR group improved, but the control group showed no improvement in depression over time).

Interestingly, this study also measured pain and sleep, but rather than reporting these as outcomes, researchers used pain and sleep as covariates in their analysis of how MBSR influenced depression. The authors did not report whether participants also experiences significant improvement in pain and sleep, although one might guess that if the researchers had found such results, they would have reported the effects.

The MBSR program has established research protocols that can be widely replicated by practitioners and researchers, and as evidenced by the number of research summaries reporting MBSR studies, the program has achieved significant success in obtaining funding and publishing data in peer-reviewed journals. It is worth noting this success and considering whether a field as diverse as Yoga, particularly with its emphasis on the individual teacher/student relationship, would ever be able to create a standardized intervention and research protocol.

Source: Journal of Clinical Oncology, 25(28), 4387-95. Oct 2007.

Authors: Moadel, A.B., Shah, C., Wylie-Rosett, J., Harris, M.S., Patel, S.R., Hall, C.B., & Sparano, J.A.

Contact: Alyson B. Moadel , College of Medicine, Department of Epidemiology and Population Health, 1300 Morris Park Ave, Bronx, NY 10461. moadel@aecom.yu.edu.

Yoga is commonly praised for reducing stress through relaxation, but a recent study suggests that it offers another key stress-reducing benefit: social connection. The finding comes from a study of the psychological and physical benefits of yoga for breast cancer patients, conducted by researchers at the Albert Einstein College of Medicine, the Montefiore Medical Center, Columbia University, and the New York State Psychiatric Institute. 128 women with breast cancer were randomly assigned to either a 12-week yoga program or a wait-list control group. The yoga program included a weekly 90-minute class that consisted of asana (poses), pranayama (breathing), and meditation. The asana practice was relatively gentle, focusing on seated and reclining poses. Participants were encouraged to practice at home and given audio instructions for support. Researchers measured participants’ subjective well-being in many areas (physical, social, emotional, and spiritual) before and after the 12-week study period. The main benefit of the yoga practice was preventing a decline in social well-being; the control group showed a significant decrease, but the yoga group did not. There were no other significant findings when comparing the two groups. However, only 48% of participants were undergoing chemotherapy treatment during the study. Researchers decided to do a second round of analyses, looking at the treatment and no-treatment participants separately. For individuals who were not undergoing chemotherapy, the yoga intervention made a significant difference in not just social well-being, but also emotional and spiritual well-being. Higher attendance rate at the classes was associated with greater improvements in emotional well-being and energy levels. Authors speculate that the participants in chemotherapy may not have shown the same global effects because they began the study in less stable and more serious medical condition than participants not undergoing treatment during the study. Importantly, this study included a diverse population (42% African American and 31% Hispanic). Previous studies and surveys suggest that the yoga community can do a better job reaching diverse populations, and this study confirms that when introduced to yoga, they experience significant emotional and social benefits.

SEATTLE — Aug. 3, 2009 — Regular yoga practice is associated with mindful eating, and people who eat mindfully are less likely to be obese, according to a study led by researchers at Fred Hutchinson Cancer Research Center.
 The study was prompted by initial findings reported four years ago by Alan Kristal, Dr.P.H., and colleagues, who found that regular yoga practice may help prevent middle-age spread in normal-weight people and may promote weight loss in those who are overweight. At the time, the researchers suspected that the weight-loss effect had more to do with increased body awareness, specifically a sensitivity to hunger and satiety than the physical activity of yoga practice itself. he follow-up study, published in the August issue of the Journal of the American Dietetic Association, confirms their initial hunch. The researchers found that people who ate mindfully – those were aware of why they ate and stopped eating when full – weighed less than those who ate mindlessly, who ate when not hungry or in response to anxiety or depression. The researchers also found a strong association between yoga practice and mindful eating but found no association between other types of physical activity, such as walking or running, and mindful eating.

"These findings fit with our hypothesis that yoga increases mindfulness in eating and leads to less weight gain over time, independent of the physical activity aspect of yoga practice," said Kristal, who is also a professor of epidemiology at the University of Washington School of Public Health.

 http://www.fhcrc.org/about/ne/news/2009/08/03/yoga.html

Cancer Update from Johns Hopkins: Cancer is a disease of the mind, body, and spirit. A proactive and positive spirit will help the cancer warrior be a survivor. Anger, un-forgiveness and bitterness put the body into a stressful and acidic environment. Learn to have a loving and forgiving spirit. Learn to relax and enjoy life.  

Cancer cells cannot thrive in an oxygenated environment. Exercising daily, and deep breathing help to get more oxygen down to the cellular level. Oxygen therapy is another means employed to destroy cancer cells.