To determine the effectiveness and safety of yoga interventions on disease symptoms, quality of life and function in patients diagnosed with chronic obstructive pulmonary disease (COPD).
Data sources:
Medline/PubMed, Scopus, and CENTRAL (Cochrane Central Register of Controlled Trials) were searched through 6 June 2019.
Review methods:
Randomized controlled trials assessing the effects of yoga on quality of life, dyspnea, exercise capacity, and pulmonary function (FEV1) in patients with COPD were included. Safety was defined as secondary outcome. Mean differences (MD) and standardized mean differences (SMD) with 95% confidence intervals (CIs) were computed. Risk of bias was assessed using the Cochrane tool.
Results:
Eleven randomized controlled trials with a total of 586 patients were included. Meta-analysis revealed evidence for effects of yoga compared to no treatment on quality of life on the COPD Assessment Test (MD = 3.81; 95% CI = 0.97 to 6.65; P = 0.009, I2 = 70%), exercise capacity assessed by the 6-minute walk test (MD = 25.53 m; 95% CI = 12.16 m to 38.90 m; P = 0.001, I2 = 0%), and pulmonary function assessed by FEV1 predicted (MD = 3.95%; 95% CI = 2.74% to 5.17%; P < 0.001, I2 = 0%). Only the effects on exercise capacity and pulmonary function were robust against methodological bias. Effects were only present in breathing-focused yoga interventions but not in interventions including yoga postures. Adverse events were reported infrequently.
Conclusion:
This meta-analysis found robust effects of yoga on exercise capacity and pulmonary function in patients with COPD. Yoga, specifically yoga breathing techniques, can be an effective adjunct intervention for patients with COPD. Yoga’s safety needs to be assessed in more depth in future studies.
McCarthyBCaseyDDevaneD, et al. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev2015; (2): CD003793, https://www.ncbi.nlm.nih.gov/pubmed/25705944
2.
BirdeeGSLegedzaATSaperRB, et al. Characteristics of yoga users: results of a national survey. J Gen Intern Med2008; 23(10): 1653–1658.
3.
BirdeeGSYehGYWaynePM, et al. Clinical applications of yoga for the pediatric population: a systematic review. Acad Pediatr2009; 9(4): 212.e1-9–220.e1-9.
4.
CramerHPosadzkiPDobosG, et al. Yoga for asthma: a systematic review and meta-analysis. Ann Allergy Asthma Immunol2014; 112(6): 503.e5–510.e5.
5.
CramerHLaucheRDobosG. Characteristics of randomized controlled trials of yoga: a bibliometric analysis. BMC Complement Altern Med2014; 14: 328.
6.
MoherDLiberatiATetzlaffJ, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ2009; 6: e1000097.
7.
HigginsJPTGreenS. Cochrane handbook for systematic reviews of interventions. West Sussex: John Wiley & Sons, Ltd., 2008.
8.
CohenJ. Statistical power analysis for the behavioral sciences. Hillsdale, NJ: Lawrence Erlbaum Associates, 1998.
9.
Donesky-CuencoDNguyenHQPaulS, et al. Yoga therapy decreases dyspnea-related distress and improves functional performance in people with chronic obstructive pulmonary disease: a pilot study. J Altern Complement Med2009; 15(3): 225–234.
10.
FukuokaAUedaMAriyamaY, et al. Effect of laughter yoga on pulmonary rehabilitation in patients with chronic obstructive pulmonary disease. J Nara Med Assoc2016; 67(1–3): 11–20.
11.
GuptaAGuptaRSoodS, et al. Pranayam for treatment of chronic obstructive pulmonary disease: results from a randomized, controlled trial. Integr Med2014; 13(1): 26–31.
12.
KaminskyDAGuntupalliKKLippmannJ, et al. Effect of yoga breathing (pranayama) on exercise tolerance in patients with chronic obstructive pulmonary disease: a randomized, controlled trial. J Altern Complement Med2017; 23(9): 696–704.
13.
KatiyarSKBihariS. Role of pranayama in the rehabilitation of COPD patients—a randomized controlled study. Ind J Allerg Appl Immunol2006; 20(2): 98–104.
14.
KulpatiDDKamathRKChauhanMR. The influence of physical conditioning by yogasanas and breathing exercises in patients of chronic obstructive lung disease. J Assoc Physicians India1982; 30(12): 865–868.
15.
RajNMoorthyAM. Yoga-based pulmonary rehabilitation for the management of dyspnea in coal miners with chronic obstructive pulmonary disease: a randomized controlled trial. Int J Res Sci Technol2017; 7(2): 113–128.
16.
RanjitaRBadhaiSHankeyA, et al. A randomized controlled study on assessment of health status, depression, and anxiety in coal miners with chronic obstructive pulmonary disease following yoga training. Int J Yoga2016; 9(2): 137–144.
17.
RanjitaRHankeyANagendraHR, et al. Yoga-based pulmonary rehabilitation for the management of dyspnea in coal miners with chronic obstructive pulmonary disease: a randomized controlled trial. J Ayurveda Integr Med2016; 7(3): 158–166.
18.
SoniRMunishKSinghK, et al. Study of the effect of yoga training on diffusion capacity in chronic obstructive pulmonary disease patients: a controlled trial. Int J Yoga2012; 5(2): 123–127.
19.
SoniRSinghSSinghKP. The effect of pranayama and yogasana on lung functions in mild and moderate chronic obstructive pulmonary disease. Biomedicine2012; 32(1): 57–60.
20.
TandonMK. Adjunct treatment with yoga in chronic severe airways obstruction. Thorax1978; 33(4): 514–517.
21.
ThokchomSKGulatiKRayA, et al. Effects of yogic intervention on pulmonary functions and health status in patients of COPD and the possible mechanisms. Complement Ther Clin Pract2018; 33: 20–26.
22.
KulpatiDDSKamathRK. The influence of physical conditioning by yogasanas and breathing exercises in patients of chronic obstructive pulmonary disease. Lung India1982; 1(1): 35–38.
23.
LiuXCPanLHuQ, et al. Effects of yoga training in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. J Thorac Dis2014; 6(6): 795–802.
24.
HollandAEHillCJJonesAY, et al. Breathing exercises for chronic obstructive pulmonary disease. Cochrane Database Syst Rev2012; 10: CD008250.
25.
Global Initiative for Chronic Obstructive Lung Disease. From the global strategy for the diagnosis, management and prevention of COPD, global initiative for chronic obstructive lung disease (GOLD), 2017, http://goldcopd.org (2017, accessed 30 April 2018).
26.
WaschkiBKirstenAHolzO, et al. Physical activity is the strongest predictor of all-cause mortality in patients with COPD: a prospective cohort study. Chest2011; 140(2): 331–342.
27.
CasaburiRPatessioAIoliF, et al. Reductions in exercise lactic acidosis and ventilation as a result of exercise training in patients with obstructive lung disease. Am Rev Respir Dis1991; 143(1): 9–18.
28.
BeaumontMForgetPCouturaudF, et al. Effects of inspiratory muscle training in COPD patients: a systematic review and meta-analysis. Clin Respir J2018; 12(7): 2178–2188.
29.
CebriaiIranzoMArnallDAIgual CamachoC, et al. Effects of inspiratory muscle training and yoga breathing exercises on respiratory muscle function in institutionalized frail older adults: a randomized controlled trial. J Geriatr Phys Ther2014; 37(2): 65–75.
30.
CramerH. The efficacy and safety of yoga in managing hypertension. Exp Clin Endocrinol Diabetes2016; 124(2): 65–70.
31.
CramerHHallerHLaucheR, et al. A systematic review and meta-analysis of yoga for hypertension. Am J Hypertens2014; 27(9): 1146–1151.
32.
StairDCRiosWABlackHR. Atypical causes of curable renovascular hypertension: a review. Prog Cardiovasc Dis1990; 33(3): 185–210.
33.
MarkilNWhitehurstMJacobsPL, et al. Yoga Nidra relaxation increases heart rate variability and is unaffected by a prior bout of Hatha yoga. J Altern Complement Med2012; 18(10): 953–958.
34.
MouryaMMahajanASSinghNP, et al. Effect of slow- and fast-breathing exercises on autonomic functions in patients with essential hypertension. J Altern Complement Med2009; 15(7): 711–717.
35.
PomidoriLCampigottoFAmatyaTM, et al. Efficacy and tolerability of yoga breathing in patients with chronic obstructive pulmonary disease: a pilot study. J Cardiopulm Rehabil Prev2009; 29(2): 133–137.
36.
BernardiLPortaCSpicuzzaL, et al. Slow breathing increases arterial baroreflex sensitivity in patients with chronic heart failure. Circulation2002; 105(2): 143–145.
37.
BernardiLSpadaciniGBellwonJ, et al. Effect of breathing rate on oxygen saturation and exercise performance in chronic heart failure. Lancet1998; 351(9112): 1308–1311.
38.
SpicuzzaLGabuttiAPortaC, et al. Yoga and chemoreflex response to hypoxia and hypercapnia. Lancet2000; 356(9240): 1495–1496.
39.
BoutronIMoherDAltmanDG, et al. Extending the CONSORT statement to randomized trials of nonpharmacologic treatment: explanation and elaboration. Ann Intern Med2008; 148(4): 295–309.
40.
SladeSCDionneCEUnderwoodM, et al. Consensus on exercise reporting template (CERT): modified Delphi study. Phys Ther2016; 96(10): 1514–1524.
41.
IoannidisJPEvansSJGotzschePC, et al. Better reporting of harms in randomized trials: an extension of the CONSORT statement. Ann Intern Med2004; 141(10): 781–788.
42.
The National Institute for Health and Care Excellence. Chronic obstructive pulmonary disease in over 16s: diagnosis and management, https://www.nice.org.uk/guidance/cg101 (2010, accessed 14 April 2018).
43.
The National Institute for Health and Care Excellence. Chronic obstructive pulmonary disease: management of chronic obstructive pulmonary disease in adults in primary and secondary care [CG101], https://www.nice.org.uk/guidance/CG101/uptake (2010, accessed 14 April 2018).
CramerHLaucheRLanghorstJ, et al. Yoga for depression: a systematic review and meta-analysis. Depress Anxiety2013; 30(11): 1068–1083.
46.
CramerHLaucheRAnheyerD, et al. Yoga for anxiety: a systematic review and meta-analysis of randomized controlled trials. Depress Anxiety2018; 35(9): 830–843.
47.
SaperRBEisenbergDMDavisRB, et al. Prevalence and patterns of adult yoga use in the United States: results of a national survey. Altern Ther Health Med2004; 10(2): 44–49.
48.
CramerHWardLSteelA, et al. Prevalence, patterns, and predictors of yoga use: results of a U.S. nationally representative survey. Am J Prev Med2016; 50(2): 230–235.
49.
PenmanSCohenMStevensP, et al. Yoga in Australia: results of a national survey. Int J Yoga2012; 5(2): 92–101.
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