Yoga for metabolic risk factors:Much ado about nothing or new form of adjunctive care?
In 2012,an estimated 20.4million Americans (8.7%of the population)practiced yoga,a number that has been growing steadily (Barnes,Bloom,&Nahin,2008;Barnes,Powell-Griner,McFann,&Nahin,2004;Yoga Journal,2012).Roughly 60%of yoga practitioners report starting yoga to alleviate stress or improve their overall health (Yoga Journal,2012).Using data from the 2002National Health Interview Survey on u of complementary and alternative medicine,Garrow and Egede (2006),found that adults with diabetes were less likely to report practicing yoga than non-diabetic adults (odds ratio =0.6,95%con fidence interval =0.4,0.7).However,more recent studies suggest that this may be changing (Bishop &Lewith,2010;Chang,Wallis,&Tiralongo,2007).
In India,yoga is commonly ud in the management of type 2diabetes and associated chronic insulin resistance conditions (Bali,2013).Guidelines for the management of type 2diabetes in India have included yoga for over a decade (Rao,Prak,&Metelko,2002).Currently,there is renewed interest in yoga as an adjunctive therapy for this condition,given that the number of Indians with diabetes is expected to reach nearly 60million by 2017(Aswathy,Unnikrishnan,&Kalra,2013).Recent studies conducted in India and elwhere have reported signi ficant improvement in measures of insulin resistance and gluco tolerance,lipid pro files,and other risk indices among adults with diabetes and r
elated disorders following the completion of yoga-bad programs (Innes,Bourguignon,&Taylor,2005;Innes &Vincent,2007;Shantakumari,Sequeira,&El deeb,2013;Telles,2012).However,while findings are promising,many of the studies are small,lack appropriate comparison groups,and/or have other design or methodological limitations that preclude de finitive conclusions regarding ef ficacy (Aljasir,Bryson,&Al-Shehri,2010;Innes &Vincent,2007).Clearly,additional high quality trials are needed.
tciThus,the publication of a large (n =180person),rigorously conducted,randomized controlled trial of yoga for persons with metabolic syndrome that has the additional strengths of an appro-priate intervention period and reasonable follow-up period should be welcome news to the medical community (Kanaya,Araneta,Pawlowsky,et al.,2014).In contrast to the findings of most previous studies,results of this trial were predominantly negative.Despite the study's large sample size and the relatively long duration of the intervention,only 4of the 11clinical indices in tho assigned to yoga showed signi ficant within group changes at 6months,and only 5of 11showed such changes at 12months.The only signi ficant between group difference reported was in fasting blood gluco (FBG).Especially surprising,given the rationale for the intervention,
was the lack of improvement with yoga at any time point in either the mental or physical component
of quality of life (QOL).Do the findings suggest that yoga is not an effective treatment for patients at risk for diabetes and thus,the positive findings of previous studies simply re flect methodological de ficiencies?Or alternatively,could the inconsistency in findings re flect differences between the studies in the intervention design,choice of comparison group,study popula-tions,or other factors?
天道教育The answer is not so clear cut.However,at least a partial explanation for the somewhat unexpected findings may rest with 1)the nature of the yoga intervention chon –storative yoga that included no active pos or meditation,and minimal breathing exercis;and 2)the choice of stretching as a control group.Prior studies of yoga for diabetes and related disorders,including metabolic syndrome have typically ud more active,integrated forms of yoga -including active postures,breathing and meditation,(Cramer,Lauche,Haller,Dobos,&Michaln,2014;Ernst &Lee,2010;Hagins,States,Selfe,&Innes,2013;Innes &Vincent,2007;Innes et al.,2005;Okonta,2012;Ross &Thomas,2010;Shantakumari et al.,2013)even with obe patients (e.g.,Cohen,Bloedon,Rothman,et al.,2011:mean BMI of 30;Lee,Kim,&Kim,2012:mean BMI not reported;Khatri,Mathur,Gahlot,Jain,&Agrawal,2007:mean BMI of 32;Manchanda et al.,2013:mean BMI of 34).Indeed,one of the bene fits of yoga is thought to be the multi-modal synergistic combination of techniques that are included in the practice (Sherman,2012).
Curiously,the authors em to have decided that the critical “active ingredient ”of yoga for patients with diabetes was passive relaxation.Thus,they implemented an intervention entirely com-prising a ries of supported pos designed to minimize muscular strain.They cite their small pilot study (with 12participants assigned to restorative yoga and 12to a usual care control)as supportive of their choice of intervention,although this study showed minimal bene fits for this patient population,even in perceived stress and other psychosocial indices (Cohen,Chang,Grady,&Kanaya,2008).
Even harder to understand is the rationale for the control group,which consisted of stretching class.It may well have contributed to the modest findings obrved.Many stretches are similar to yoga asanas (postures).In fact,the stretching intervention was designed by a physical therapist and a yoga expert.Stretching exercis produce some of the same bene fits,including improved strength,posture,flexibility and range of motion,and coordination,as well improved circulation and mood,incread relaxation,and reduced stress.U of a stretching comparison group,particularly in this study where there was signi ficantly greater social interaction and physical activity in the stretching group,may have rved to “control ”for not only the non-
parachute什么意思>dw是什么意思Journal of Diabetes and Its Complications 28(2014)253–254
Con flict of Interest:The authors have no con flicts of interest to
report.1056-8727/$–e front matter ©2014Elvier Inc.All rights rerved.
dx.doi/10.1016/j.jdiacomp.2014.03.001
Contents lists available at ScienceDirect
Journal of Diabetes and Its Complications
j o u rn a l h o m e p a g e :W WW.J D C J O U R N A L.C OM
specific effects,but may have“overcontrolled”for social interaction and for certain specific effects typically obrved with more active forms of yoga,thus further diminishing the likelihood of detecting an effect.Inclusion of a usual care control group may have helped to address some of the issues.
Despite the concerns,the study demonstrated that both groups were able to make significant lifestyle changes,incread physical activity and reduced caloric intake.The authors note that the improvement in fasting gluco levels is similar to what was found in the Diabetes Prevention Project at the one year follow-up.The authors conclude that restorative yoga and active stretching warrant further study as possible adjunctive or alternative treatments for patients at risk for type2diabetes.However,given the concerns detailed above and the promisingfindings of many previous studies, we recommend that future studies incorporate more active, integrated yoga interventions shown to be effective in similar,at risk populations.
References
Aljasir,B.,Bryson,M.,&Al-Shehri,B.(2010,Dec).Yoga practice for the management of type II diabetes mellitus in adults:a systematic review.Evidence-bad Complementary and Alternative Medicine,7(4),399–408.
Aswathy,S.,Unnikrishnan,A.G.,&Kalra,S.(2013,Jan).Effective management of type2 DM in India:looking at low-cost adjunctive therapy.Indian Journal of Endocrinology and Metabolism,17(1),149–152.
Bali,H.K.(2013,Mar-Apr).Yoga-an ancient solution to a modern epidemic.Ready for prime time?Indian Heart Journal,65(2),132–136.
locationbadrvice
Barnes,P.M.,Bloom,B.,&Nahin,R.L.(2008,Dec10).Complementary and alternative medicine u among adults and children:United States,2007.National Health Statistics Reports,12,1–23.
Barnes,P.M.,Powell-Griner,E.,McFann,K.,&Nahin,R.L.(2004).Complementary and alternative medicine u among adults:United States,2002.Advance Data(343), 1–19.
Bishop,F.L.,&Lewith,G.T.(2010).Who us CAM?A narrative review of demographic characteristics and health factors associated with CAM u.eCAM,7(1),11–28. Chang,H.-y.,Wallis,M.,&Tiralongo,E.(
英语四六级考试网2007).U of complementary and alternative medicine among people living with diabetes:literature review.Journal of Advanced Nursing,58(4),307–319.
kmdCohen,D.L.,Bloedon,L.T.,Rothman,R.L.,Farrar,J.T.,Galantino,M.L.,Volger,S.,et al.
(2011).Iyengar yoga versus enhanced usual care on blood pressure in patients with prehypertension to stage I hypertension:a randomized controlled trial.Evidence-bad Complementary and Alternative Medicine,2011,546428.
Cohen,B.E.,Chang,A.A.,Grady,D.,&Kanaya,A.M.(2008,Sep).Restorative yoga in adults with metabolic syndrome:a randomized,controlled pilot trial.Metabolic Syndrome and Related Disorders,6(3),223–229.
Cramer,H.,Lauche,R.,Haller,H.,Dobos,G.,&Michaln,A.(2014,Feb3).A systematic review of yoga for heart dia.European Journal of Preventive Cardiology[Epub ahead of print].
hopperErnst,E.,&Lee,M.S.(2010).How effective is yoga?A conci overview of systematic reviews.Focus on Alternative and Complementary Therapies,15,274–279.Garrow, D.,&Egede,L. E.(2006,Nov).National patterns and correlates of complementary and alternative medicine u in adults with diabetes.Journal of Alternative and Complementary Medicine,12(9),895–902.
Hagins,M.,States,R.,Selfe,T.,&Innes,K.(2013).Effectiveness of yoga for hypertension: systematic review and meta-analysis.Evidence-bad Complementary and Alternative Medicine,2013,649836.
Innes,K.E.,Bourguignon,C.,&Taylor,A.G.(2005,Nov-Dec).Risk indices associated with the insulin resistance syndrome,cardiovascular dia,and possible protection with yoga:a systematic review.Journal of the American Board of Family Practice,18(6),491–519.
Innes,K.E.,&Vincent,H.K.(2007,Dec).The influence of yoga-bad programs on risk profiles in adults with type2diabetes mellitus:a systematic review.Evidence-bad Complementary and Alternative Medicine,4(4),469–486.
Kanaya,A.M.,Araneta,M.R.,Pawlowsky,S.B.,Barrett-Connor,E.,Grady,D.,Vittinghoff,
E.,Schembri,M.,Chang,A.,Carrion-Petern,M.,Coggins,T.,Tanori,D.,Armas,J.M.,
&Cole,R.J.(2014).Restorative yoga and metabolic risk factors:the Practicing Restorative Yoga vs.Stretching for the Metabolic Syndrome(PRYSMS)randomized trial.Journal of Diabetes and its Complications,28(3),406–412.
a c care
Khatri,D.,Mathur,K.C.,Gahlot,S.,Jain,S.,&Agrawal,R.P.(2007,Dec).Effects of yoga and meditation on
clinical and biochemical parameters of metabolic syndrome.
Diabetes Rearch and Clinical Practice,78(3),e9–e10.
Lee,J.A.,Kim,J.W.,&Kim,D.Y.(2012,Mar).Effects of yoga exerci on rum adiponectin and metabolic syndrome factors in obe postmenopausal women.
Menopau,19(3),296–301.
Manchanda,S.C.,Mehrotra,U.C.,Makhija,A.,Mohanty,A.,Dhawan,S.,&Sawhney,J.P.S.
(2013).Reversal of early atherosclerosis in metabolic syndrome by yoga–a randomized controlled trial.Journal of Yoga&Physical Therapy,1(3).dx.doi.
org/10.4172/2157-7595.1000132.
Okonta,N.R.(2012).Does yoga therapy reduce blood pressure in patients with hypertension?:an integrative review.Holistic Nursing Practice,26(3),137–141. Rao,M.B.,Prak,M.,&Metelko,Z.(2002).Organisation of diabetes health care in Indian rural areas.Diabetologia Croatica,31(3),161–171.
Ross,A.,&Thomas,S.(2010,Jan).The health benefits of yoga and exerci:a review of comparison studies.Journal of Alternative and Complementary Medicine,16(1), 3–12.
Shantakumari,N.,Sequeira,S.,&El deeb,R.(2013,Mar-Apr).Effects of a yoga intervention on lipid profiles of diabetes patients with dyslipidemia.Indian Heart Journal,65(2),127–131.
Sherman,K.J.(2012).Guidelines for developing yoga interventions for randomized trials.Evidence-bad Complementary and Alternative Medicine,2012,143271. Telles,S.(2012).Scientific yoga rearch in India.SENSE,2(2),9–15.
Yoga Journal(2012).Yoga in America /press/yoga_ in_america[Accesd2/26/14]
Karen J.Sherman
escapes
Group Health Rearch Institute
1720Minor Ave Suite1600
Seattle WA981201
E-mail address:sherman.k@ghc
ksherman@u.washington.edu
Kim E.Innes
Department of Epidemiology West Virginia University School of Public Health,PO Box
9190Morgantown,WV26506
254Editorial/Journal of Diabetes and Its Complications28(2014)253–254
