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While yoga seems to be effective in a number of neuropsychiatric disorders, the evidence of efficacy in multiple sclerosis remains unclear. The aim of this review was to systematically assess and meta-analyze the available data on efficacy and safety of yoga in patients with multiple sclerosis. Mood, cognitive function, and safety were defined as secondary outcome measures. Risk of bias was assessed using the Cochrane tool. Seven RCTs with a total of patients were included. The effects on fatigue and mood were not robust against bias.
No short-term or longer term effects of yoga compared to exercise were found. Yoga was not associated with serious adverse events. In conclusion, since no methodological sound evidence was found, no recommendation can be made regarding yoga as a routine intervention for patients with multiple sclerosis. Yoga might be considered a treatment option for patients who are not adherent to recommended exercise regimens.
This is an open-access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability: The authors confirm that all data underlying the findings are fully available without restriction. Data are available from the published RCTs from which they were extracted.
The funding source had no influence on the design or conduct of the review; the collection, management, analysis, or interpretation of the data; or in the preparation, review, or approval of the manuscript.
Competing interests: The authors have declared that no competing interests exist. Multiple sclerosis is the most common chronic autoimmune inflammatory disease of the central nervous system and the leading cause of disability in young adults  , . Multiple sclerosis is mainly characterized by impaired health-related quality of life, fatigue, and reduced mobility  — .
Other common symptoms include cognitive impairment, depression, and emotional lability  , . Yoga is rooted in Indian philosophy and has been a part of traditional Indian spiritual practice for millennia . Yoga traditionally is a complex intervention that comprises not only physical activity but also advice for ethical lifestyle, spiritual practice, breathing exercises, and meditation.
While the ultimate goal of traditional yoga has been described as uniting mind, body, and spirit, yoga has become a popular means to promote physical and mental well-being  , . In North America and Europe, yoga is most often associated with physical postures asanas , breathing techniques pranayama , and meditation dhyana ; and different yoga forms have emerged that put varying focus on physical and mental practices .
In North America and Europe, yoga is gaining increased popularity as a therapeutic method. Indeed, about half of American yoga practitioners more than 13 million people reported that they had started practice explicitly to improve their health  , . While systematic reviews and meta-analyses have evaluated the efficacy and safety of yoga for a number neuropsychiatric disorders  —  , the evidence of efficacy of yoga in multiple sclerosis has not yet been systematically assessed.
Thus, the aim of this review was to systematically evaluate and meta-analyze the available data on efficacy and safety of yoga in improving health-related quality of life, fatigue, mobility, mood, and cognitive function in patients with multiple sclerosis.
The review protocol was developed a priori and not modified during the conduct of the review. Randomized controlled trials RCTs , randomized cross-over studies, and cluster-randomized trials were eligible.
No language restrictions were applied. No restrictions were made regarding yoga tradition, length, frequency or duration of the program. Studies on multimodal interventions that include yoga amongst others were excluded. Studies allowing individual co-interventions were eligible. Control: Studies comparing yoga to usual care, exercise, or other active non-pharmacological control interventions were eligible.
To be eligible for inclusion, studies had to assess at least one primary outcome as recommended by an international, multi-disciplinary consensus meeting  :.
The literature search was constructed around search terms for 1. Two reviewers independently screening and selected abstracts; potentially eligible articles were read in full by two reviewers. Disagreements were settled through a discussion with a third reviewer until consensus was reached. If necessary, additional information was obtained from the authors of the primary study. Two reviewers independently extracted data on patients e.
Discrepancies were discussed with a third reviewer until consensus was reached. Two reviewers independently assessed risk of bias using the Cochrane risk of bias tool . This tool assesses risk of bias on seven domains: random sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessment, incomplete outcome data, selective reporting, and other sources of bias.
For each domain, risk of bias was assessed as low; unclear; or high risk of bias. Discrepancies were discussed with a third reviewer until consensus was achieved. Separate meta-analyses were conducted for comparisons of yoga to different control interventions. Meta-analyses were conducted using Review Manager 5 software Version 5. Where no standard deviations were available, they were calculated from standard errors, confidence intervals or t-values  , or attempts were made to obtain the missing data from the trial authors by email.
A positive SMD i. If necessary, values were inverted . Statistical heterogeneity between studies was analyzed using the I 2 statistics, a measure of how much variance between studies can be attributed to differences between studies rather than chance. The Chi 2 test was used to assess whether differences in results are compatible with chance alone. Subgroup analyses were planned for the type of yoga intervention yoga interventions including physical postures vs.
As all included studies comprised yoga postures, subgroup analyses could not be performed. To test the robustness of significant results, sensitivity analyses were conducted for studies with high versus low risk of bias at the following domains: selection bias random sequence generation and allocation concealment , detection bias blinding of outcome assessment , and attrition bias incomplete outcome data.
If present in the respective meta-analysis, subgroup and sensitivity analyses were also used to explore possible reasons for statistical heterogeneity. If at least 10 studies were included in a meta-analysis, assessment of publication bias was originally planned by using funnel plots generated using Review Manager software  , .
As less than 10 studies were included in each meta-analysis, funnel plots could not be analyzed. The literature search retrieved 96 non-duplicate records of which 87 were excluded on the basis of title and abstract because they did not meet all pre-defined inclusion criteria Table S1. Nine full-text articles were assessed for eligibility  — . All nine full-text articles reporting on seven RCTs involving a total of patients met the inclusion criteria and were included in the qualitative analysis and meta-analysis Figure 1.
One full-text article was published in Persian  , the others in English. Characteristics of the sample, interventions, outcome assessment, and results are shown in Table 1. Of the seven studies that were included, three originated from Iran  —  ,  ; two from Ireland  —  ; and one each from the USA  ; and Slovenia . Patients were recruited from hospitals  —  , multiple sclerosis societies  —  or multiple sclerosis foundations .
Only three studies reported on the type of multiple sclerosis, all three studies included patients with all types of multiple sclerosis  —  , .
The sample size ranged from 20 to with a median of Between Ethnicity was not reported in any study. Three studies used Hatha Yoga  —  ,  ; one used Iyengar Yoga  ; two did not predefine the yoga intervention but let the yoga teachers decide on content of the intervention  —  ; and one did not report the yoga style used .
All seven studies used yoga postures and meditation or relaxation; six also used yogic breathing techniques  —  , . The duration of yoga programs ranged from eight weeks to six months with a median of 10 weeks; frequency of yoga interventions ranged from one to three median: 1 weekly yoga sessions of 60 to 90 median: Six studies compared yoga to usual care or no specific treatment  — .
Five studies compared yoga to exercise including treadmill training  ,  ; aerobic exercise  ; mixed aerobic and resistance exercise  —  ; or sports climbing . Except for one study where the yoga sessions were longer in duration than the exercise session  ,  , the yoga and exercise interventions were exactly matched for program length, and frequency and duration of the sessions. All seven studies assessed outcomes immediately after the end of the intervention; one study also assessed longer-term effects 12 weeks after the end of the intervention  , .
Mobility was assessed using the m timed walk test  ,  , the foot timed walk test  , the 2-minute walk test  ,  , or the 6-minute walk test  — . Two studies assessed cognitive function using standardized neuropsychological test batteries  ,  table 2. Four studies reported safety-related data  ,  ,  ,  ,  , . Risk of bias in individual studies is shown in figure 2. One study each had reported adequate random sequence generation  or allocation concealment  ,  ; and three studies each reported adequate blinding of outcome assessement  —  or were free of suspected selective reported  ,  , .
Four studies reported safety-related data. One of those reported adverse events: one exacerbation in each group occurred, and four further adverse events were reported that were not related to the study interventions . In another study, no exacerbation occurred in any of the three groups  , . In another study, three patients in the yoga group were lost to follow-up after the intervention due to medical reasons including exacerbations compared to four, five, and eight patients in the physiotherapist-led exercise, fitness instructor-led exercise, and usual care group, respectively  , .
In the fourth study, zero, two, three, and one patients were lost to follow-up after the intervention due to medical reasons in the yoga, group physiotherapy, individual physiotherapy, and control group, respectively .
Since no study had low risk of selection or attrition bias, no effect remained significant in sensitivity analyses for low risk of selection or attrition bias. No other effects remained significant table 2. In this systematic review of seven randomized trials on yoga for multiple sclerosis, evidence for positive short-term effects of yoga on fatigue and mood, but not on more objective physician-rated outcomes such as mobility or cognitive function were found.
No effect was robust against potential methodological bias. Although the overall high risk of bias hinders definite conclusions, yoga seems to be equally effective as exercise interventions in improving both patient-reported and physician-rated outcomes. Safety of the intervention was insufficiently reported. Specifically, only one study explicitly assessed adverse events.
However, exacerbations of multiple sclerosis were fewer or equal in number in the groups compared to the usual care or exercise groups. This is in line with previous cross-sectional studies  ,  and systematic reviews of yoga interventions in other patient populations that found no evidence for serious yoga-associated adverse events  — . It should however be considered that yoga has occasionally been associated with serious adverse events in case studies .
No systematic review specifically on yoga for multiple sclerosis was available. However, a recent review on studies on mind-body medicine for multiple sclerosis published until March  included one RCT on yoga . This review concluded that while yoga improved multiple sclerosis-related fatigue with fewer side effects than conventional treatment, more research was needed to draw definite conclusions.
A recent systematic review on exercise for multiple sclerosis concluded that exercise therapy including yoga  may have beneficial effects on patients with multiple sclerosis without adverse events and might thus be recommended for the rehabilitation of multiple sclerosis patients .
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Evan T. Barone, J. Background: This pilot study determined the feasibility of a specifically designed 8-week yoga program for people with moderate multiple sclerosis MS —related disability. We explored the program's effect on quality of life QOL and physical and mental performance. Methods: We used a single-group design with repeated measurements at baseline, postintervention, and 8-week follow-up.
Background: Muscle weakness, fatigue and balance disturbances contribute to the reduction of daily activity in multiple sclerosis MS patients. Therapeutic strategies to promote improvements in muscle strength , functional capacity and balance are limited in individuals with MS. Yoga training YT is a most popular mind-body intervention and has been known to positively affect physical, mental and other symptoms of multiple sclerosis patients with moderate disability and other cases. Strength training as a physical exercise has positive effects in performance and some disabilities in these patients. Objectives: This study was designed to determine effect of 8-week home-based YT and resistance training RT on muscle strength, functional capacity and balance in 26 patients with MS with mild to moderate disability. Methods: 26 male and female patients Age: Conclusions: In conclusion, it seems that prescribing regular training programs with controlled intensity and time, particularly RT and Hatha yoga training can have a positive impact on the lower limbs strength and some degree of balance improvement in multiple sclerosis patients.
PDF | Multiple Sclerosis (MS) is an immune-mediated process in which the body's immune system damages myelin in the central nervous.
While yoga seems to be effective in a number of neuropsychiatric disorders, the evidence of efficacy in multiple sclerosis remains unclear. The aim of this review was to systematically assess and meta-analyze the available data on efficacy and safety of yoga in patients with multiple sclerosis. Mood, cognitive function, and safety were defined as secondary outcome measures. Risk of bias was assessed using the Cochrane tool. Seven RCTs with a total of patients were included.
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Skip to search form Skip to main content You are currently offline. Some features of the site may not work correctly. DOI: Cramer and R. Lauche and H.
experience mild symptoms of MS and are able to participate in mat yoga classes (i.e., they can .org/cmsc/ images/pdf/YogaForMS_DaliaZwickpdf.
PDF | While yoga seems to be effective in a number of neuropsychiatric disorders, the evidence of efficacy in multiple sclerosis remains unclear.Marc B. 23.03.2021 at 20:31
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