BACKGROUND & AIMS:This review aims to systematically survey the effects of yoga on symptoms of irritable bowel syndrome (IBS), pain, quality of life, mood, stress, and safety in patients with IBS.

METHODS:MEDLINE/Pubmed, Scopus, the Cochrane Library, CAM-QUEST, CAMbase, and IndMED were screened through November 2015. Randomized controlled trials comparing yoga with usual care, nonpharmacologic, or pharmacologic interventions were analyzed for patients with IBS. Primary outcomes included gastrointestinal symptoms, quality of life, and pain. Anxiety, mood, and safety were defined as secondary outcomes. Risk of bias was assessed according to the Cochrane Collaboration recommendations.

RESULTS:Six randomized controlled trials with a total of 273 patients were included in the qualitative analysis. There was evidence for a beneficial effect of a yogic intervention over conventional treatment in IBS, with significantly decreased bowel symptoms, IBS severity, and anxiety. Furthermore, there were significant improvements in quality of life, global improvement, and physical functioning after yoga compared with no treatment. Two randomized controlled trials reported safety data stating that no adverse events occurred. Overall, risk of bias of the included studies was unclear.

CONCLUSIONS:The findings of this systematic review suggest that yoga might be a feasible and safe adjunctive treatment for people with IBS. Nevertheless, no recommendation can be made regarding yoga as a routine intervention for patients with IBS because of major flaws in study methods. More research is needed with respect to a high-quality study design and consensus in clinical outcome measurements in IBS.

OBJECTIVE:We aimed to determine the effect of yoga on arterial function in elderly with increased pulse pressure (PP).

DESIGN:Randomized controlled study with two parallel groups.

PARTICIPANTS:Elderly subjects with PP≥60 mmHg (n=60).

INTERVENTIONS:Yoga group (n=30) was assigned for yoga training and brisk-walking (BW) group (n=30) for brisk-walk with stretching exercise for 1h in the morning for 6 days in a week for 12 weeks.

MAIN OUTCOME MEASURES:Arterial stiffness measures: Brachial-ankle pulse wave velocity (baPWV), Carotid-femoral pulse wave velocity (c-f PWV), aortic augmentation index (AIx@75), arterial stiffness index at brachial (bASI) and tibial arteries (aASI). Total serum nitric oxide concentration (NOx) as an index of endothelial function. Heart rate variability (HRV) measures: Low frequency and high frequency in normalized units (LFnu, HFnu) and LF/HF ratio.

RESULTS:The mean between-group change (with 95% CI) in arterial stiffness: c-f PWV(m/s) [1.25(0.59-1.89); p<0.001], baPWV(m/s) [1.96(0.76-3.16), p<0.01], AIx@75 [3.07(0.24-5.89), p=0.066], aASI [8.3(4.06-12.53), p<0.001]; endothelial function index: NO(μmol/L) [-9.03(-14.57 to -3.47), p<0.001]; SBP(mmHg) [14.23(12.03-16.44), p<0.001], DBP(mmHg) [0.1(-1.95-2.15), p=0.38], PP(mmHg) [14.07(11.2-16.92), p<0.001], MAP(mmHg) [4.7(3.08-6.32), p<0.001]; and cardiac autonomic function: LF(nu) [4.81(1.54-8.08), p<0.01], HF(nu) [-4.13(-7.57 to -0.69), p<0.01], LF/HF ratio [0.84(0.3-1.37), p<0.001], indicate significant difference in effects of two intervention on arterial stiffness, endothelial function, BP and cardiac autonomic activity. There was significant change within-yoga group in vascular function, BP and autonomic function, while no significant change within-BW group was observed.

CONCLUSION:Our findings suggest that yoga program offered was more effective than brisk-walk in reducing arterial stiffness along with BP in elderly individuals with increased PP. Yoga can also significantly reduce sympathetic activity and improve endothelial function with enhancement in bioavailability of NO.

OBJECTIVES:To observe the effect of yoga on menopausal symptoms using a prospective, randomized, controlled and interventional study. Main outcome measures Total Menopause Rating Scale (MRS) score and three subscale scores (somatovegetative, psychological and urogenital) were measured on day 1 and day 90 in the study group which performed yoga (asana, pranayam and meditation) under supervision for three months, and were compared with the control group that did not perform yoga. MRS has been designed to measure health-related quality of life of ageing women. It consists of 11 symptoms and three subscales.

RESULTS:It was observed that on day 1 the scores in both the groups were comparable. On day 90, the scores in the yoga group showed a reduction in score on all the subscales, which was statistically significant. No significant difference was noted in the control group.

CONCLUSION:Yoga is effective in reducing menopausal symptoms and should be considered as alternative therapy for the management of menopausal symptoms.

CONTEXT: In two of the earlier Randomized Control Trials on yoga for chronic lower back pain (CLBP), 12 to 16 weeks of intervention were found effective in reducing pain and disability. AIM: To study the efficacy of a residential short term intensive yoga program on quality of life in CLBP. MATERIALS AND METHODS: About 80 patients with CLBP (females 37) registered for a week long treatment at SVYASA Holistic Health Centre in Bengaluru, India. They were randomized into two groups (40 each). The yoga group practiced a specific module for CLBP comprising of asanas (physical postures), pranayama (breathing practices), meditation and lectures on yoga philosophy. The control group practiced physical therapy exercises for back pain. Perceived stress scale (PSS) was used to measure baseline stress levels. Outcome measures were WHOQOL Bref for quality of life and straight leg raising test (SLR) using a Goniometer. RESULTS: There were significant negative correlations (Pearson's, P<0.005, r>0.30) between baseline PSS with all four domains and the total score of WHOQOLBref. All the four domains' WHOQOLBref improved in the yoga group (repeated measures ANOVA P=0.001) with significant group*time interaction (P<0.05) and differences between groups (P<0.01). SLR increased in both groups (P=0.001) with higher increase in yoga (31.1 % right, 28.4 % left) than control (18.7% right, 21.5 % left) group with significant group*time interaction (SLR right leg P=0.044). CONCLUSION: In CLBP, a negative correlation exists between stress and quality of life. Yoga increases quality of life and spinal flexibility better than physical therapy exercises.

BACKGROUND: 'Dry eye' appears to be the main contributor to the symptoms of computer vision syndrome. Regular breaks and the use of artificial tears or certain eye drops are some of the options to reduce visual discomfort. A combination of yoga practices have been shown to reduce visual strain in persons with progressive myopia. The present randomized controlled trial was planned to evaluate the effect of a combination of yoga practices on self-rated symptoms of visual discomfort in professional computer users in Bangalore. METHODS: Two hundred and ninety one professional computer users were randomly assigned to two groups, yoga (YG, n = 146) and wait list control (WL, n = 145). Both groups were assessed at baseline and after sixty days for self-rated visual discomfort using a standard questionnaire. During these 60 days the YG group practiced an hour of yoga daily for five days in a week and the WL group did their usual recreational activities also for an hour daily for the same duration. At 60 days there were 62 in the YG group and 55 in the WL group. RESULTS: While the scores for visual discomfort of both groups were comparable at baseline, after 60 days there was a significantly decreased score in the YG group, whereas the WL group showed significantly increased scores. CONCLUSION: The results suggest that the yoga practice appeared to reduce visual discomfort, while the group who had no yoga intervention (WL) showed an increase in discomfort at the end of sixty days.

BACKGROUND:The purpose of the present study is to explore the effect of yoga on the serum levels of homocysteine and nitric oxide (NO) in a cohort of women with primary dysmenorrhea and normal healthy controls.

METHODS:A prospective controlled trial was conducted in 35 women with primary dysmenorrhea and 35 healthy controls in a community-based study. Short-form Menstrual Distress Questionnaires (MDQs) were administered to assess the menstrual symptoms. All participants were provided yoga intervention, twice a week at 30 minutes/session, consecutively for 8 weeks. Blood samples were drawn from each woman on the third day of the menstrual cycle. Assessments of MDQs and blood samples for the determination of homocysteine and NO concentrations were performed at baseline and within the first 3 days of their next menses after completion of yoga intervention.

RESULTS:A total of 30 women from the dysmenorrheal group and 30 from the control group completed the study. Homocysteine levels were higher in those with dysmenorrhea when compared with healthy controls before yoga intervention (Mann-Whitney U test, p<0.05); however, no statistically significant differences were found between the two groups after 8 weeks of yoga training (p<0.05). The concentrations of homocysteine in both the dysmenorrheal and control groups after 8 weeks decreased by 51.37% and 46.46%, respectively (p<0.001). There were no statistically significant differences in NO levels between the two groups at baseline and after intervention. The total scores on the MDQs decreased significantly after yoga intervention in the dysmenorrheal group (p<0.05).

CONCLUSIONS:Yoga intervention was found to be associated with reductions in severity of dysmenorrhea and may be effective in lowering serum homocysteine levels after an intervention period of 8 weeks. These observations suggest that yoga may have therapeutic effects in women by restoring endothelial function.

BACKGROUND AND OBJECTIVES:To evaluate the effect of yoga practice and exercise challenge on Tumour Necrosis Factor alpha (TNF-α), Interleukin-6 (IL-6) levels and lipid profile.

MATERIALS AND METHODS:Two hundred and eighteen subjects participated in the study. One hundred and nine volunteers (51 males and 58 females) in the age group of 20 to 60 years, who practiced yoga regularly for over five years for a period of one hour daily, performed a bout of moderate exercise and a bout of strenuous exercise as per Standardized Shuttle Walk test protocol. Anthropometrically matched, age matched and gender matched subjects, who did not practice yoga (non-yoga group) were chosen as controls (non-yoga, n=109). The non-yoga group also performed similar exercises. The blood samples of both the groups were collected before and after the exercises. TNF-α and IL-6 was analysed before and after the exercise by Sandwich ELISA (Enzyme Linked Immunosorbent Assay).

RESULTS:Resting plasma TNF-α concentration was significantly higher in non-yoga group when compared to yoga group (p<0.05). There was an increase in TNF-α levels in both the groups in response to strenuous exercise. There was no gender difference in TNF-α and IL-6 levels before and after exercise in yoga and non-yoga groups.

CONCLUSION:Regular practice of yoga lowers basal TNF-α and IL-6 levels. It also reduces the extent of increase of TNF-α and IL-6 to a physical challenge of moderate exercise and strenuous exercise. There is no significant gender difference in the TNF-α and IL-6 levels. Regular practice of yoga can protect the individual against inflammatory diseases by favourably altering pro-inflammatory cytokine levels.

CONTEXT:Yoga therapy has been demonstrated to be useful in treatment of negative symptoms and improving the socio-occupational functioning and emotion recognition deficits in antipsychotic-stabilized schizophrenia patients. Oxytocin has been recently implicated in social cognition deficits in schizophrenia. The effect of yoga therapy on oxytocin levels in schizophrenia has not been studied.

AIMS:This study aimed to assess the effect of yoga therapy on symptoms, socio-occupational functioning, facial emotion recognition deficits and plasma oxytocin levels in antipsychotic stabilized schizophrenia patients.

SETTINGS AND DESIGN:Randomized controlled study on 43 consenting, medication stabilized patients with schizophrenia in a tertiary psychiatric center using yoga intervention and waitlisted groups.

MATERIALS AND METHODS:A total of 43 schizophrenia patients were randomized to yoga group (n=15) or waitlist group (n=28). Patients in the yoga group received training in a specific yoga therapy module for schizophrenia. Patients in both groups were continued on stable antipsychotic medication. Assessments included scale for assessment of positive symptoms, scale for assessment of negative symptoms, socio-occupational functioning scale and tool for recognition of emotions in neuropsychiatric disorders (TRENDS) and plasma oxytocin levels; performed at baseline and at the end of 1 month.

RESULTS:A total of 15 patients in the yoga group and 12 in waitlist group completed the study. The yoga therapy group showed a significant improvement in socio-occupational functioning, performance on TRENDS (P<0.001) and plasma increase in oxytocin levels (P=0.01) as compared with the waitlist group.

CONCLUSION:The study supported the role of add-on yoga therapy in management of schizophrenia and demonstrated an improvement in endogenous plasma oxytocin levels in schizophrenia patients receiving yoga therapy.

There is evidence that the practice of yoga improves physical and mental performance. The present investigation was undertaken to study the effect of yoga training on visual and auditory reaction times (RTs), maximum expiratory pressure (MEP), maximum inspiratory pressure (MIP), 40 mmHg test, breath holding time after expiration (BHTexp), breath holding time after inspiration (BHTinsp), and hand grip strength (HGS). Twenty seven student volunteers were given yoga training for 12 weeks. There was a significant (P<0.001) decrease in visual RT (from 270.0 +/- 6.20 (SE) to 224.81 +/- 5.76 ms) as well as auditory RT (from 194.18 +/- 6.00 to 157.33 +/- 4.85 ms). MEP increased from 92.61 +/- 9.04 to 126.46 +/- 10.75 mmHg, while MIP increased from 72.23 +/- 6.45 to 90.92 +/- 6.03 mmHg, both these changes being statistically significant (P<0.05). 40 mmHg test and HGS increased significantly (P<0.001) from 36.57 +/- 2.04 to 53.36 +/- 3.95 s and 13.78 +/- 0.58 to 16.67 +/- 0.49 kg respectively. BHTexp increased from 32.15 +/- 1.41 to 44.53 +/- 3.78s (P<0.01) and BHTinsp increased from 63.69 +/- 5.38 to 89.07 +/- 9.61 s (P<0.05). Our results show that yoga practice for 12 weeks results in significant reduction in visual and auditory RTs and significant increase in respiratory pressures, breath holding times and HGS.

BACKGROUND:Inflammatory bowel disease (IBD) is a chronic illness characterized by gross inflammation in the gastrointestinal tract that can result in symptoms such as abdominal pain, cramping, diarrhea, and bloody stools. IBD is believed to be influenced by psychological factors such as stress and anxiety. Therefore, a yoga intervention that reduces stress and anxiety may be an effective complementary treatment for these disorders.

MATERIAL AND METHODS:A total of 100 IBD patients [ulcerative colitis (UC) n = 60 and Crohn's disease (CD) n = 40] during the clinical remission phase of disease were included in the study. These patients were allocated randomly to either the yoga group that underwent an 8-week yoga intervention (physical postures, pranayama, and meditation) 1- hour/day in addition to standard medical therapy (UC, n = 30; CD, n = 20) or the control group (UC, n = 30; CD n = 20), which continued with standard medical therapy alone. The main outcome measures were cardiovascular autonomic functions, serum eosinophilic cationic protein, interleukin- 2 soluble receptors, Speilberger's State Trait Anxiety Inventory (STAI) scores, and clinical symptoms.

RESULTS:Before the intervention, all the outcome measures were comparable in the two groups. After the 8-week yoga intervention, fewer UC patients reported arthralgia. The number of patients reporting intestinal colic pain in the control group was higher. State and trait anxiety levels were significantly reduced in patients with UC. However, no significant changes were observed in cardiovascular autonomic functions, eosinophilic cationic proteins, or interleukin-2 soluble receptors.

CONCLUSIONS:A simplified yoga-based regimen is a safe and effective complementary clinical treatment modality for patients with inflammatory bowel disease during the clinical remission phase.

Diabetes is a metabolic disorder, which has become a major health challenge worldwide. South East Asian countries have a highest burden of diabetes. In India the prevalence of diabetes is rising rapidly especially in the urban population because of increasing obesity and reduced physical activity. An objective of this study is to evaluate the effect of Yoga-Nidra on blood glucose level in diabetic patients. This study was conducted on 41, middle aged, type-2 diabetic patients, who were on oral hypoglycaemic. These patients were divided in to two groups: (a) 20 patients on oral hypoglycaemic with yoga-nidra, and (b) 21 were on oral hypoglycaemic alone. Yoga-nidra practiced for 30 minutes daily up to 90 days, parameters were recorded every. 30th day. Results of this study showed that most of the symptoms were subsided (P<0.004, significant), and fall of mean blood glucose level was significant after 3-month of Yoga-nidra. This fall was 21.3 mg/dl, P<0.0007, (from 159 +/- 12.27 to 137.7 +/- 23.15,) in fasting and 17.95 mg/dl, P = 0.02, (from 255.45 +/- 16.85 to 237.5 +/- 30.54) in post prandial glucose level. Results of this study suggest that subjects on Yoga-nidra with drug regimen had better control in their fluctuating blood glucose and symptoms associated with diabetes, compared to those were on oral hypoglycaemics alone.

Forty eight healthy volunteers who participated in the practice of yoga over a period of 4 months were assessed on Subjective Well Being Inventory (SUBI) before and after the course in order to evaluate the effect of practice of yoga on subjective feelings of well-being and quality of life. A significant improvement in 9 of the 11 factors of SUBI was observed at the end of 4 months, in these participants. The paper thus, reiterates the beneficial effects of regular practice of yoga on subjective well being.

PURPOSE:This study aimed at determining the effectiveness of super brain yoga for children with hyperactivity disorder.

DESIGN AND METHOD:This quasiexperimental and interventional research was conducted on 80 school-age children through a pretest-posttest design.

RESULTS:Results showed that there was a significant difference between the means of severity of hyperactivity disorder before (75.1) and after the intervention (63.5) (p < .001).

PRACTICE IMPLICATIONS:Practicing super brain yoga reduced the symptoms of hyperactivity disorder among the school-age children.

BACKGROUND: Numerous studies have explored the effectiveness of complementary and alternative medicine in the treatment of migraine but there is no documented investigation of the effectiveness of yoga therapy for migraine management. OBJECTIVES: To investigate the effectiveness of holistic approach of yoga therapy for migraine treatment compared to self-care. DESIGN: A randomized controlled trial. METHODS: Seventy-two patients with migraine without aura were randomly assigned to yoga therapy or self-care group for 3 months. Primary outcomes were headache frequency (headache diary), severity of migraine (0-10 numerical scale) and pain component (McGill pain questionnaire). Secondary outcomes were anxiety and depression (Hospital anxiety depression scale), medication score. RESULTS: After adjustment for baseline values, the subjects' complaints related to headache intensity (P<.001), frequency (P<.001), pain rating index (P<.001), affective pain rating index (P<.001), total pain rating index (P<.001), anxiety and depression scores (P<.001), symptomatic medication use (P<.001) were significantly lower in the yoga group compared to the self-care group. CONCLUSION: The study demonstrated a significant reduction in migraine headache frequency and associated clinical features, in patients treated with yoga over a period of 3 months. Further study of this therapeutic intervention appears to be warranted.

INTRODUCTION:The quality of life (QOL) of substance users is known to be impaired. Sudarshan Kriya Yoga (SKY), a yogic breathing program has potential to improve QOL and needs evaluation in an Indian setting.

AIMS:Study aimed to assess changes in QOL in treatment seeking male opioid dependent users following practice of SKY program.

SETTINGS AND DESIGN:Users were randomized into study (n = 55) and control group (n = 29). Study group besides standard treatment (long term pharmacotherapy with buprenorphine in flexible dosing schedule) underwent a 3 days, 12 h SKY program while control group received standard treatment alone.

MATERIALS AND METHODS:World Health Organization QOL-brief scale was used to measure QOL and urine tested to assess recent drug use. Assessments were made at baseline and at 3 and 6 months.

STATISTICAL ANALYSIS:Data were analyzed using generalized estimation equation to assess within group change with time and the overall difference between groups for changes at assessment points.

RESULTS:Overtime within study group, all four QOL domain scores were significantly higher at 6 months. Between group comparison showed significant increase in physical (P<0.05); psychological (P<0.001) and environment domains (P<0.001) for study group while control group showed significant changes in social relationship domain only. Urine screening results were negative for study group indicating no drug use at 6 months.

CONCLUSION:SKY as a complementary therapy was found beneficial in improving QOL for group practicing it and is recommended for use as low cost and low-risk adjunct in substance treatment settings in India.

INTRODUCTION:The quality of life (QOL) of substance users is known to be impaired. Sudarshan Kriya Yoga (SKY), a yogic breathing program has potential to improve QOL and needs evaluation in an Indian setting.

AIMS:Study aimed to assess changes in QOL in treatment seeking male opioid dependent users following practice of SKY program.

SETTINGS AND DESIGN:Users were randomized into study (n = 55) and control group (n = 29). Study group besides standard treatment (long term pharmacotherapy with buprenorphine in flexible dosing schedule) underwent a 3 days, 12 h SKY program while control group received standard treatment alone.

MATERIALS AND METHODS:World Health Organization QOL-brief scale was used to measure QOL and urine tested to assess recent drug use. Assessments were made at baseline and at 3 and 6 months.

STATISTICAL ANALYSIS:Data were analyzed using generalized estimation equation to assess within group change with time and the overall difference between groups for changes at assessment points.

RESULTS:Overtime within study group, all four QOL domain scores were significantly higher at 6 months. Between group comparison showed significant increase in physical (P<0.05); psychological (P<0.001) and environment domains (P<0.001) for study group while control group showed significant changes in social relationship domain only. Urine screening results were negative for study group indicating no drug use at 6 months.

CONCLUSION:SKY as a complementary therapy was found beneficial in improving QOL for group practicing it and is recommended for use as low cost and low-risk adjunct in substance treatment settings in India.

Descilo T, Vedamurtachar A, Gerbarg PL, Nagaraja D, Gangadhar BN, Damodaran B, Adelson B, Braslow LH, Marcus S, Brown RP. Effects of a yoga breath intervention alone and in combination with an exposure therapy for PTSD and depression in survivors of the 2004 South-East Asia tsunami.Objective: This study evaluated the effect of a yoga breath program alone and followed by a trauma reduction exposure technique on post-traumatic stress disorder and depression in survivors of the 2004 Asian tsunami. Method: In this non-randomized study, 183 tsunami survivors who scored 50 or above on the Post-traumatic Checklist-17 (PCL-17) were assigned by camps to one of three groups: yoga breath intervention, yoga breath intervention followed by 3-8 h of trauma reduction exposure technique or 6-week wait list. Measures for post-traumatic stress disorder (PCL-17) and depression (BDI-21) were performed at baseline and at 6, 12 and 24 weeks. Data were analyzed using anova and mixed effects regression. Results: The effect of treatment vs. control was significant at 6 weeks (F(2,178) = 279.616, P<0.001): mean PCL-17 declined by 42.5 +/- 10.0 SD with yoga breath, 39.2 +/- 17.2 with Yoga breath + exposure and 4.6 +/- 13.2 in the control. Conclusion: Yoga breath-based interventions may help relieve psychological distress following mass disasters.

Objectives. This study compares the effects of an integrated yoga program with brief supportive therapy in breast cancer outpatients undergoing adjuvant radiotherapy at a cancer center. METHODS: Eighty-eight stage II and III breast cancer outpatients are randomly assigned to receive yoga (n = 44) or brief supportive therapy (n = 44) prior to radiotherapy treatment. Assessments include diurnal salivary cortisol levels 3 days before and after radiotherapy and self-ratings of anxiety, depression, and stress collected before and after 6 weeks of radiotherapy. RESULTS: Analysis of covariance reveals significant decreases in anxiety (P<.001), depression (P = .002), perceived stress (P<.001), 6 a.m. salivary cortisol (P = .009), and pooled mean cortisol (P = .03) in the yoga group compared with controls. There is a significant positive correlation between morning salivary cortisol level and anxiety and depression. CONCLUSION: Yoga might have a role in managing self-reported psychological distress and modulating circadian patterns of stress hormones in early breast cancer patients undergoing adjuvant radiotherapy.

BACKGROUND: Dance and yoga have been shown to produce improvements in psychological well-being.

PURPOSE: The aim of this study was to examine some of the psychological and neuroendocrine response to these activities.

METHODS: Sixty-nine healthy college students participated in one of three 90-min classes: African dance (n = 21), Hatha yoga (n= 18), or a biology lecture as a control session (n = 30). Before and after each condition participants completed the Perceived Stress Scale (PSS), completed the Positive Affect and Negative Affect Schedule, and provided a saliva sample for cortisol. RESULTS: There were significant reductions in PSS and negative affect (ps < .0001) and Time x Treatment interactions (ps < .0001) such that African dance and Hatha yoga showed significant declines, whereas there was no significant change in biology lecture. There was no significant main effect for positive affect (p = .53), however there was a significant interaction effect (p < .001) such that positive affect increased in African dance, decreased in biology lecture, and did not change significantly in Hatha yoga. There was a significant main effect for salivary cortisol (p < .05) and a significant interaction effect (p < .0001) such that cortisol increased in African dance, decreased in Hatha yoga, and did not change in biology. Changes in cortisol were not significantly related to changes in psychological variables across treatments. There was 1 significant interaction effect (p = .04) such that change in positive affect and change in cortisol were negatively correlated in Hatha yoga but positively correlated in Africa dance and biology.

CONCLUSIONS: Both African dance and Hatha yoga reduced perceived stress and negative affect. Cortisol increased in African dance and decreased in Hatha yoga. Therefore, even when these interventions produce similar positive psychological effects, the effects may be very different on physiological stress processes. One factor that may have particular salience is that amount of physiological arousal produced by the intervention.

BACKGROUND:Various studies have shown the efficacy of conventional isometric, Pilates and yoga exercises. However, data on the effects and comparison of these specific exercises on the cervical muscle morphology are insufficient or lacking.

OBJECTIVE:To investigate the effects of different exercise treatments on neck muscles in patients with chronic neck pain.

DESIGN:A randomized study.

METHODS:Fifty-six patients with chronic neck pain were randomized into 3 groups as follows: Pilates group (n = 20), yoga group (n = 18) and isometric group (n = 18). Demographics and background information were recorded. The thickness and cross-sectional area of neck muscles were evaluated by ultrasound imaging. Cervical motions were measured with a goniometer. Pain severity was evaluated withthe McGill Pain Scale, disability with the Neck Disability Index, quality of life with the Nottingham Health Profile, and emotional status with the Beck Depression Inventory. In addition to a conventional physio-therapy programme, 15 sessions of physical therapy, including hot pack, ultrasound, andtranscutaneous electrical nerve stimulation (TENS), were provided to all patients. All groups performed the exercises for 6 weeks. The aforementioned assessments were performed before and 6 weeks after the treatment.

RESULTS:Although pain, disability, depression and quality of life improved similarly within all groups (all p < 0.05), muscle thickness values as regards the semispinalis capitis were increased only in the Pilates group (p = 0.022).

STUDY LIMITATIONS:The lack of complex (progressive resistive) exercise treatment protocols, short treatment duration and partial supervision.

CONCLUSION:All 3 types of exercise had favourable effects on pain and functional scores, but no differences were found among the groups, except for the Pilates group, in which the semispinalis capitis muscle increased in thickness.