Yoga, A holistic approach to chronic health condition: A review of literature
Diabetes Mellitus (DM) is one of leading causes of mortality and morbidity around the globe with its clinical presence affecting the economics of most developed nations. Hypertension, chronic low back pain, diabetes, dyslipidaemia, and depression are all lifestyle related health conditions which can be easily prevented. Based on current evidence, chronic psychological stress is associated with glucose intolerance, hypertension, insulin resistance, metabolic syndrome, and dyslipidaemia which are risk factors for cardiovascular disease (Bali. 2013).
Based on recent evaluation on complimentary and alternate treatments that are associated with the psychosocial factors of chronic disease such as diabetes, hypertension, and dyslipidaemia. These mind-body therapies are linked with the prevention of most chronic health conditions. Based on these recommendations, a 4000 year old technique, Yoga has been widely accepted as an alternate therapy for chronic conditions such as diabetes, hypertension, and dyslipidaemia. Yoga is known to have seven major branches, of which Mantra, Raja (classical), and Hatha (Forceful) are known to be widely practiced. The yoga techniques, Raja and Hatha are known to focus on postures (known as asanas) in relaxation and active poses including concentration (dharanas), breath control (pranayama), and meditation (dhyana). Most healthcare providers consider yoga as a safe and easy-to-learn alternate therapy since it is non-invasive, requires little equipment, inexpensive or professional training. However, Yoga was known to be criticized in western countries at early stages due to its conflict with modern medicine and practice. Furthermore, there were few studies that supported the practice of Yoga as an effective and safe alternate therapy for specific indications. Many researchers have now proposed the practice of yoga with published evidence on its effects on the psychological well-being of patients suffering from chronic health conditions. In recent years, may researchers have claimed that the practice of yoga is useful in the prevention and management of chronic health conditions such as hypertension, diabetes and dyslipidaemia (Bali. 2013).
Role of Yoga in the Prevention and Management of Diabetes, Hypertension, Dyslipidaemia, Chronic Low Back pain, and Depression: There have been more than 50 studies since 1970 that have highlighted the potential use of Yoga as an alternate therapy for the management of chronic health conditions (Bali. 2013). Most research was published in international and peer-reviewed journals focused on the influence of yoga and yoga-related programs on the mind and body of individuals with chronic diseases. (Bali. 2013). Most of the research was based on the assessment of yoga in measuring lipid profiles, insulin resistance, blood pressure, body weight and cardiovascular risk. The interventions in most research studies ranges from 30 days to 12 months and covered all age groups including serious chronic conditions such as coronary artery disease, hypertension, and type II diabetes (Bali. 2013).
Evidence on the practice of yoga in chronic healthcare management: A pilot randomized controlled study was conducted to assess the preliminary efficacy and feasibility of yoga interventions on various risk factors for diabetes such as postprandial blood glucose, insulin resistance, BMI changes, blood pressure and cholesterol. The psychological well-being such as depression, anxiety, and stress was also evaluated (McDermott, et al. 2014). In a similar study design, a randomized controlled study was conducted to assess the effectiveness of yoga interventions on lipid profiles of patients with type 2 diabetes and dyslipidaemia for a period of 3 months (Shantakumari, Sequeira, & El deeb, 2013). A systematic review was conducted on recent research to assess the health benefits and psychological well-being of yoga intervention in patients with hypertension and associated health complications with a focus on clinical guidelines and heterogeneity of yoga practice (Tyagi & Cohen. 2014). A systematic review by a team of researchers also assess the health benefits of yoga intervention in patients with chronic low back pain (Chang, et al. 2016). A systematic review and meta-analysis was conducted to assess the use of yoga practice on depression in patients with chronic disease such as diabetes, CVD, hypertension, and dyslipidaemia (Cramer, et al. 2013).
Evidence on Yoga Interventions
The first study was a pilot randomized controlled study based in Bangalore, India. A total of 41 participants were recruited in the study, with 20 participants receiving yoga as an intervention while 21 participants were assigned to walk. The intervention was carried out for 8 weeks with participants given an option to attend yoga or complete monitored walking for at least 3 to 6 days a week. The data was analysed on the basis of intention to treat (McDermott, et al. 2014). The second study was a randomized parallel study based in Kerala, India. A total of 100 participants were recruited for the study and were randomly assigned to control and treatment groups. The control group included hypoglycaemic drugs. The intervention was assessed for a period of 3 months, with lipid profiles assessed before and after intervention (Shantakumari, Sequeira, & El deeb, 2013). The third study was based on a systematic review that comprised of 48 RCTs, 39 cohort studies, 30 non-RCTs, and 3 case reports. The duration of yoga intervention for hypertension ranged from 1 week to 4 years with a total of 6693 participants (Tyagi & Cohen. 2014).
The fourth study comprised of a systematic review of literature published since 2015 on the effect of yoga intervention on chronic low back pain. A total of 27 articles were reviewed with treatment intervention ranging from 30 days to 24 weeks (Chang, et al. 2016). The fifth study was based on a meta-analysis and systematic review from papers published after 2013. A total of 12 RCTs were included in the study with 619 participants (Cramer, et al. 2013).
Results of the study: All the five studies highlighted the safety, effectiveness, and feasibility of yoga intervention in patients with chronic health conditions. Based on the review of all five studies, yoga intervention was observed to reduce risk factors for CVD, diabetes, and stroke. Yoga was also observed to help in glucose intolerance, insulin resistance, and improve lipid profiles. Psychological well-being such as depression, stress, and anxiety also improved.
Mind-Body Techniques and the Nurse Practitioner
Nurse practitioners play a key role in the care and management of patients with chronic conditions. In a few clinical studies, nurse practitioners have been observed to encourage complementary and alternative medicine (CAM) for individuals with chronic conditions such as diabetes, hypertension, and dyslipidaemia. Yoga and Music therapy are one of the most widely accepted, safe, and effective interventions for better and improved health outcomes among patients with chronic diseases such as diabetes and hypertension (Mandel, et al. 2013). Based on current evidence, music therapy has been a safe, effective, and widely accepted intervention to reduce risk factors of diabetes. In a feasibility study comprising of 199 patients with a 3-group, randomized controlled parallel study, researchers stated that a combination of music-assisted relaxation and imagery, administered via compact disc recording (MARI CD) and diabetes self-management education/training (DSME/T) was found to reduce systolic blood pressure in patients with diabetes and comorbid hypertension. (Mandel, et al. 2013). In a recent systematic review and meta-analysis, researchers proved that music therapy was associated with lower systolic blood pressure in hypertensive patients (do Amaral, et al. 2016). Thus, nurse practitioners can adopt music therapy as an alternate for management of diabetes patients with hypertension (DiNardo, et al. 2012).
Nurse practitioners should also consult physicians to include Yoga as an alternate therapy for patients with diabetes and hypertension. Based on current evidence, yoga is known to improve autonomic function, reduce anxiety and stress, improves physical health, and boost confidence among patients with chronic health disease (Sengupta, 2012). Thus, it can be concluded that complementary and alternative medicine is a proven, safe, and effective intervention for management of chronic conditions such as diabetes, hypertension, dyslipidaemia, chronic low back pain, and depression. Nurse practitioners and healthcare professionals should implement such effective and feasible interventions for better health outcomes (DiNardo, et al. 2012).
References
Bali, H. K. (2013). Yoga – an ancient solution to a modern epidemic. Ready for prime time? Indian Heart Journal, 65(2), 132–136. http://doi.org/10.1016/j.ihj.2013.03.002
Chang, D. G., Holt, J. A., Sklar, M., & Groessl, E. J. (2016). Yoga as a treatment for chronic low back pain: A systematic review of the literature. Journal of Orthopedics & Rheumatology, 3(1), 1–8.
Cramer H, Lauche R, Langhorst J, Dobos G. (2013). Yoga for depression: a systematic review and meta-analysis. Depress Anxiety. 2013 Nov;30(11):1068-83.
do Amaral MA, Neto MG, de Queiroz JG, Martins-Filho PR, Saquetto MB, Oliveira Carvalho V. (2016). Effect of music therapy on blood pressure of individuals with hypertension: A systematic review and Meta-analysis. Int J Cardiol. 2016 Jul 1;214:461-4.
DiNardo MM, Gibson JM, Siminerio L, Morell AR, Lee ES. (2012). Complementary and alternative medicine in diabetes care. Curr Diab Rep. 2012 Dec;12(6):749-61.
Mandel SE, Davis BA, Secic M. (2013). Effects of music therapy and music-assisted relaxation and imagery on health-related outcomes in diabetes education: a feasibility study. Diabetes Educ. 2013 Jul-Aug;39(4):568-81.
McDermott, K. A., Rao, M. R., Nagarathna, R., Murphy, E. J., Burke, A., Nagendra, R. H., & Hecht, F. M. (2014). A yoga intervention for type 2 diabetes risk reduction: a pilot randomized controlled trial. BMC Complementary and Alternative Medicine, 14, 212. http://doi.org/10.1186/1472-6882-14-212
Sengupta, P. (2012). Health Impacts of Yoga and Pranayama: A State-of-the-Art Review. International Journal of Preventive Medicine, 3(7), 444–458.
Shantakumari, N., Sequeira, S., & El deeb, R. (2013). Effects of a yoga intervention on lipid profiles of diabetes patients with dyslipidemia. Indian Heart Journal, 65(2), 127–131. http://doi.org/10.1016/j.ihj.2013.02.010
Tyagi A, Cohen M. (2014). Yoga and hypertension: a systematic review. Altern Ther Health Med. 2014 Mar-Apr;20(2):32-59.
