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Effect of 6 Months of Yoga Practice on Quality of Life Among Patients With Advances in Integrative Medicine 6 (2019) 163–166 Contents lists available at ScienceDirect Advances in Integrative Medicine journal homepage: www.elsevier.com/locate/aimed Effect of 6 months of yoga practice on quality of life among patients with asthma: A randomized control trial a b, c d M. Malarvizhi , K. Maheshkumar *, M. Bhavani , B. Hariprasad a Faculty of Nursing, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India b Department of Physiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India c Department of Human Genetics, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India d Department of Chest and Tuberculosis, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India A R T I C L E I N F O A B S T R A C T Article history: Introduction: As a holistic therapy, yoga has the potential to relieve both the physical and psychological Received 5 July 2017 sufferings of people with asthma. This study was conducted to assess the effectiveness of yoga therapy as Received in revised form 8 November 2018 an adjunctive tool in the management of mild to moderate asthma with the routine conventional care. Accepted 3 December 2018 Methods: A total of 250 adult patients with mild to moderate (FEV1 > 60%) bronchial asthma were Available online 11 December 2018 recruited from the respiratory medicine department and randomly allocated to either the yoga (intervention) group (n = 125) or control group (n = 125). All patients remained on their usual care, while Keywords: the yoga group received an intervention based on yoga, in addition to usual care. The intervention Asthma consisted of 2-weeks supervised training on yoga followed by a closely monitored continuation of the Quality of life Yoga practices at home for 6 months. Quality of life was assessed using Asthma Quality of Life Questionnaire Adjuvant therapy (AQOL) at baseline, 3rd month and after the 6 months interval for both the group patients. Results: The baseline characteristics were similar in both groups. Post-intervention, the yoga group (130.48 Æ 12.43) showed better trends of improvement in total AQOL score than the control group (78.82 Æ 4.37). In comparison to the various domains in AQOL such as symptoms (P < 0.001), functional limitations (P < 0.001), emotional functions (P < 0.001) and environmental stimuli (P < 0.001) also showed a significant improvement in yoga group compared to control. Conclusion: This study shows that simple yoga practice is an effective tool for the enhancement in quality of life of asthmatic patients and can be practiced as an adjuvant therapy to regular conventional care for the better outcome of asthma. © 2018 Elsevier Ltd. All rights reserved. 1. Introduction [3]. Asthma is a chronic health problem in the community that usually encompasses the patient's entire life and may result in Asthma is a common chronic inflammatory disorder character- physical, emotional, and social limitations for patients. These ized by hypersensitivity of the airways and reversible, periodic limitations often impair quality of life in many different ways [4]. It airway obstruction [1]. It is a complex and multifaceted condition has been documented that the impairment of quality of life in causing significant impairment of physical and psychosocial well- asthma patients is proportional to the severity of disease[5], and being in the affected individual. Typical symptoms of asthma acquires more significance since traditional parameters such as include shortness of breath, wheezing, coughing, and chest lung function have a weak association with quality of life [6]. The tightness. In addition to physiologic dysfunction, several people classic treatment of asthma therefore includes combinations of with asthma also experience psychological distress in the form of inhaled corticosteroids and bronchodilators, allergen avoidance, anxiety, depression, and emotional disorders [2]. Globally, more lifestyle modification, and sometimes non-pharmacological meth- than 300 million people have asthma and it is estimated that ods (including breathing exercise, yoga, pranayama, and inspira- approximately 250,000 annual deaths are attributed to the disease tory muscle training) [7,8]. A number of non-pharmacologic methods are increasingly popular in the management of asthma in adults [9]. Yoga is one of the more popular non-pharmacologic methods and has been * Corresponding author at: Department of Physiology, Sri Ramachandra institute practiced all over the world for improved functioning of body and of Higher Education and Research, Porur, Chennai, India. E-mail address: [email protected] (M. K.). mind [10]. In recent years, more asthmatics are showing interest https://doi.org/10.1016/j.aimed.2018.12.001 2212-9588/© 2018 Elsevier Ltd. All rights reserved. 164 M. M. et al. / Advances in Integrative Medicine 6 (2019) 163–166 towards yoga due to its reputed physical and psychological 2.5. Blinding/masking benefits [11 ]. Several studies on the efficacy of a various form of breathing techniques in asthma have been conducted, which have All participants were blind to their allocation into the yoga reported some improvements among asthmatic patients, includ- group and the control group treatments. The investigator who ing reduction of symptoms, less beta-adrenergic use and reduced assessed the AQOL questionnaire was blind to the yoga and control airway hyper-reactivity, improved lung function and improved group participants. quality of life [12,13]. Most of these studies have used breathing techniques as an intervention for asthma control but none of 2.6. Yoga intervention them have considered the practice of asana (posture) in a yoga context. With this limitation of previous studies in mind, the Yoga group subjects received 30 min of yoga training (Table 1) present study was conducted with an aim to assess the effect of for a week under a trained yoga teacher and advised to practice at yoga training with the combination of posture and breathing home daily once a day for 6 months. It consist of basic asanas techniques on quality of life in patients with mild to moderate (posture) like bhujangasana (cobra pose), tadasana (tree pose) and bronchial asthma. gomukhasana (cow face pose) for ten minutes and simple pranayama (breathing exercise), nadi sudhipranayama and bhas- 2. Methods trika pranayama for ten minutes followed by relaxation (OM chanting and shavasana). A yoga checklist booklet was given to the 2.1. Experimental design subjects to assess the level of performance and monitor the practice. On regular visits to outpatient department (OPD) days, The present study is a randomized controlled trial (RCT). The subjects were asked to show return demonstration and their rd th control group received conventional care whereas the yoga group doubts were clarified. During this period at 3 and 6 months, received, in addition to conventional care, an intervention based on subjects were assessed through yoga performance checklist for yoga which includes basic asanas (postures) and pranayama their level of practice on yoga techniques. Lacunas made during the (breathing techniques). The subjects from both groups were on practice were corrected and reinforced. bronchodilators in the form of inhalers or inhaled corticosteroids depending on the judgment of the treating physician. The outcome 2.7. Outcome measured measures were assessed in both groups at 0 months (baseline), 3rd th and 6 month. Quality of life was measured by using a self-administered Asthma Quality of Life Questionnaire (AQOL) which is available 2.2. Subjects in the bilingual form, i.e. English and Tamil [16]. The AQOL is a 32-item disease-specific questionnaire that has been validated The subjects were adult patients having mild or moderate to measure the problems that adult patients with asthma bronchial asthma who came to the outpatient department of experience in their daily lives [17] and has also been validated Respiratory medicine in Sri Ramachandra Medical hospital. on Indian population [18]. Subjects responded to each question Institutional Ethical clearance (IEC-NI/12/AUG/29/33) was on a 7-point scale (1 being maximum impairment; 7 being no obtained from the host institution for the current study and impairment). The overall quality of life score is the mean score of informed consent also exercised after explaining the detailed all the 32 items. Thus the score may vary from 1 to 7. The 32 procedures of the study to the patients. The potential subjects items were further grouped into four sub-domains: symptoms, went through a step-wise screening procedure. The inclusion activity limitation, emotional function, and reactivity to criteria consisted of asthmatic patients of either sex and were environmental stimuli. The score for each sub-domain was also aged between 21 and 60 years, who met Global Initiatives for calculated as the mean score for items pertaining to that sub- Asthma (GINA) criteria, who had a minimum of two years since domain. diagnosis and under medical treatment, who were not practic- ing yoga, were non-smokers, were able to understand either 2.8. Statistical analysis English or Tamil and were willing to participate in the study [14]. Subjects were excluded if they had severe airflow Data expressed as Mean Æ SD. Paired, unpaired t-test and one- limitation (FEV1 < 60%), smokers, had a history of co-morbid way ANOVA was used to compare the mean difference using R illness (medical, neurologic and psychiatric, orthopedics), had statistical software of the 3.2.3 version. associated chronic respiratory diseases such as tuberculosis, autoimmune lung diseases or if they practiced yoga or any other similar discipline. Table 1 Yogic techniques practiced by Yoga group. 2.3. Sample size Yoga technique Duration (min) The sample size (power-0.8, n = 250) for this study was Asana 1. Bhujangasana 3 calculated based on the previous study reported by Sodhi et al.
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