A yoga & exercise randomized controlled trial for vasomotor symptoms: Effects on heart rate variability. Evidence-based review of therapies at the menopause. A pilot study of a Hatha yoga treatment for menopausal symptoms. Yoga of Awareness program for menopausal symptoms in breast cancer survivors: results from a randomized trial Menopausal quality of life: RCT of yoga, exercise, and omega-3 supplements. Effect of yoga on menopausal symptoms Effects of Yoga and Aerobic Exercise on Actigraphic Sleep Parameters in Menopausal Women with Hot Flashes. Yoga as a complementary treatment for smoking cessation: rationale, study design and participant characteristics of the Quitting-in-Balance study Comparison of yoga versus stretching for chronic low back pain: protocol for the Yoga Exercise Self-care (YES) trial Physiological and psychological effects of Hatha-Yoga exercise in healthy women. Yoga decreases insomnia in postmenopausal women: a randomized clinical trial Physical activity and mental health outcomes during menopause: A randomized controlled trial Effects of Pharmacologic and Nonpharmacologic Interventions on Insomnia Symptoms and Self-reported Sleep Quality in Women With Hot Flashes: A Pooled Analysis of Individual Participant Data From Four MsFLASH Trials Effects of Yoga on Heart Rate Variability and Depressive Symptoms in Women: A Randomized Controlled Trial. Yoga as a complementary treatment for smoking cessation in women. Ayurveda and Yoga in Cardiovascular Diseases. Feasibility and acceptability of restorative yoga for treatment of hot flushes: a pilot trial. A pilot study of a randomized controlled trial of yoga as an intervention for PTSD symptoms in women. The therapeutic value of yoga in neurological disorders Treatment of Vasomotor Symptoms of Menopause with Black Cohosh, Multibotanicals, Soy, Hormone Therapy, or Placebo Lack of perceived sleep improvement after 4-month structured exercise programs Comparing Yoga, Exercise, and a Self-Care Book for Chronic Low Back Pain Lifestyle Modification in Blood Pressure Study II (LIMBS): study protocol of a randomized controlled trial assessing the efficacy of a 24 week structured yoga program versus lifestyle modification on blood pressure reduction.
OBJECTIVES Heart rate variability ( HRV ) reflects the integration of the parasympathetic nervous system with the rest of the body . Studies on the effects of yoga and exercise on HRV have been mixed but suggest that exercise increases HRV . We conducted a secondary analysis of the effect of yoga and exercise on HRV based on a r and omized clinical trial of treatments for vasomotor symptoms in peri/post-menopausal women . DESIGN R and omized clinical trial of behavioral interventions in women with vasomotor symptoms ( n=335 ) , 40 - 62 years old from three clinical study sites . INTERVENTIONS 12-weeks of a yoga program , design ed specifically for mid-life women , or a supervised aerobic exercise-training program with specific intensity and energy expenditure goals , compared to a usual activity group . MAIN OUTCOME MEASURES Time and frequency domain HRV measured at baseline and at 12 weeks for 15min using Holter monitors . RESULTS Women had a median of 7.6 vasomotor symptoms per 24h .  Time and frequency domain HRV measures did not change significantly in either of the intervention groups compared to the change in the usual activity group . HRV results did not differ when the analyses were restricted to post-menopausal women . CONCLUSIONS Although yoga and exercise have been shown to increase parasympathetic-mediated HRV in other population s , neither intervention increased HRV in middle-aged women with vasomotor symptoms . Mixed results in previous research may be due to sample differences . Yoga and exercise likely improve short-term health in middle-aged women through mechanisms other than HRV Background and Objective The highest level of scientific evidence available for each therapy for menopausal symptoms was sought , for example , systematic review s of r and omised controlled trials ( RCTs ) . Results There is reasonable evidence that some symptoms are modified by lifestyle , for example , cessation of smoking , exercise , reduction of alcohol , diet and alleviation of psychosocial stress . No complementary medicine , for example , phytoestrogens , black cohosh , herbal or homeopathic medicines or complementary therapies , for example , acupuncture , yoga , chiropractic manipulation , reflexology or magnetic devices have a greater effect than the usual placebo effect seen in quality blinded RCTs . Some have potential side-effects . So-called ' bioidentical hormones ' have no evidence -base and potential for harm . None of the above therapies have evidence of efficacy and long-term safety . Selective serotonin and noradrenaline re-uptake inhibitors ameliorate vasomotor symptoms and sometimes menopausal depression better than placebo . The most effective therapy for menopausal ( oestrogen ) deficiency symptoms is oestrogen which is the main component of hormone replacement therapies ( HRT ) . Compared with placebo HRT is highly effective in relieving hot flushes , night sweats , dry vagina and dyspareunia . It also improved joint pains , sexuality and sleeplessness and reduced subsequent fractures in RCTs . The increased risk of oral HRT for thromboembolism is small around menopause , for those without thrombotic risk factors , and is not elevated with non-oral routes . Cardiovascular disease may be reduced when HRT is initiated near menopause . Breast cancer risk increases after several years with the use of oral HRT containing progestogens at an annual rate of 8/10 000 ( < 0.1 % ) . No increase in breast cancer risk was seen with oestrogen-only HRT OBJECTIVE To assess the feasibility and efficacy of a yoga treatment for menopausal symptoms . Both physiologic and self-reported measures of hot flashes were included . METHODS A prospect i ve within-group pilot study was conducted . Participants were 12 peri- and post-menopausal women experiencing at least 4 menopausal hot flashes per day , at least 4 days per week . Assessment s were administered before and after completion of a 10-week yoga program . Pre- and post-treatment measures included : Severity of question naire-rated menopausal symptoms ( Wiklund Symptom Check List ) , frequency , duration , and severity of hot flashes ( 24-h ambulatory skin-conductance monitoring ; hot-flash diary ) , interference of hot flashes with daily life ( Hot Flash Related Daily Interference Scale ) , and subjective sleep quality ( Pittsburgh Sleep Quality Index ) .  Yoga classes included breathing techniques , postures , and relaxation poses design ed specifically for menopausal symptoms . Participants were asked to practice at home 15 min each day in addition to weekly classes . RESULTS Eleven women completed the study and attended a mean of 7.45 ( S.D. 1.63 ) classes . Significant pre- to post-treatment improvements were found for severity of question naire-rated total menopausal symptoms , hot-flash daily interference ; and sleep efficiency , disturbances , and quality . Neither 24-h monitoring nor accompanying diaries yielded significant changes in hot flashes . CONCLUSIONS The yoga treatment and study procedures were feasible for midlife women . Improvement in symptom perceptions and well being warrant further study of yoga for menopausal symptoms , with a larger number of women and including a control group Goal of workBreast cancer survivors have limited options for the treatment of hot flashes and related symptoms . Further , therapies widely used to prevent recurrence in survivors , such as tamoxifen , tend to induce or exacerbate menopausal symptoms . The aim of this preliminary , r and omized controlled trial was to evaluate the effects of a yoga intervention on menopausal symptoms in a sample of survivors of early-stage breast cancer ( stages IA – IIB ) . Material s and methods Thirty-seven disease-free women experiencing hot flashes were r and omized to the 8-week Yoga of Awareness program ( gentle yoga poses , meditation , and breathing exercises ) or to wait-list control . The primary outcome was daily reports of hot flashes collected at baseline , posttreatment , and 3 months after treatment via an interactive telephone system . Data were analyzed by intention to treat . Main results At posttreatment , women who received the yoga program showed significantly greater improvements relative to the control condition in hot-flash frequency , severity , and total scores and in levels of joint pain , fatigue , sleep disturbance , symptom-related bother , and vigor . At 3 months follow-up , patients maintained their treatment gains in hot flashes , joint pain , fatigue , symptom-related bother , and vigor and showed additional significant gains in negative mood , relaxation , and acceptance . Conclusions This pilot study provides promising support for the beneficial effects of a comprehensive yoga program for hot flashes and other menopausal symptoms in early-stage breast cancer survivors OBJECTIVE The purpose of this study was to determine the efficacy of 3 nonhormonal therapies for the improvement of menopause-related quality of life in women with vasomotor symptoms . STUDY DESIGN We conducted a 12-week 3 × 2 r and omized , controlled , factorial design trial . Peri- and postmenopausal women , 40 - 62 years old , were assigned r and omly to yoga ( n = 107 ) , exercise ( n = 106 ) , or usual activity ( n = 142 ) and also assigned r and omly to a double-blind comparison of omega-3 ( n = 177 ) or placebo ( n = 178 ) capsules . We performed the following interventions : ( 1 ) weekly 90-minute yoga classes with daily at-home practice , ( 2 ) individualized facility-based aerobic exercise training 3 times/week , and ( 3 ) 0.615 g omega-3 supplement , 3 times/day . The outcomes were assessed with the following scores : Menopausal Quality of Life Question naire ( MENQOL ) total and domain ( vasomotor symptoms , psychosocial , physical and sexual ) . RESULTS Among 355 r and omly assigned women who average age was 54.7 years , 338 women ( 95 % ) completed 12-week assessment s.  Mean baseline vasomotor symptoms frequency was 7.6/day , and the mean baseline total MENQOL score was 3.8 ( range , 1 - 8 from better to worse ) with no between-group differences . For yoga compared to usual activity , baseline to 12-week improvements were seen for MENQOL total -0.3 ( 95 % confidence interval , -0.6 to 0 ; P = .02 ) , vasomotor symptom domain ( P = .02 ) , and sexuality domain ( P = .03 ) scores . For women who underwent exercise and omega-3 therapy compared with control subjects , improvements in baseline to 12-week total MENQOL scores were not observed . Exercise showed benefit in the MENQOL physical domain score at 12 weeks ( P = .02 ) . CONCLUSION All women become menopausal , and many of them seek medical advice on ways to improve quality of life ; little evidence -based information exists . We found that , among healthy sedentary menopausal women , yoga appears to improve menopausal quality of life ; the clinical significance of our finding is uncertain because of the modest effect Objectives . To observe the effect of yoga on  menopausal symptoms  using a prospect i ve , r and omized , 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 design ed 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 STUDY OBJECTIVES To determine effects of yoga and aerobic exercise compared with usual activity on objective assessment s of sleep in midlife women . METHODS Secondary analyses of a r and omized controlled trial in the Menopause Strategies : Finding Lasting Answers for Symptoms and Health ( MsFLASH ) network conducted among 186 late transition and postmenopausal women aged 40 - 62 y with hot flashes . Women were r and omized to 12 w of  yoga , supervised aerobic exercise , or usual activity . The mean and coefficient of variation ( CV ) of change in actigraph sleep measures from each intervention group were compared to the usual activity group using linear regression models . RESULTS Baseline values of the primary sleep measures for the entire sample were mean total sleep time ( TST ) = 407.5 ± 56.7 min ; mean wake after sleep onset ( WASO ) = 54.6 ± 21.8 min ; mean CV for WASO = 37.7 ± 18.7 and mean CV for number of long awakenings > 5 min = 81.5 ± 46.9 . Changes in the actigraphic sleep outcomes from baseline to weeks 11 - 12 were small , and none differed between groups . In an exploratory analysis , women with baseline Pittsburgh Sleep Quality Index higher than 8 had significantly reduced TST-CV  following yoga compared with usual activity . CONCLUSIONS This study adds to the currently scant literature on objective sleep outcomes  from yoga and aerobic exercise interventions for this population . Although small effects on self-reported sleep quality were previously reported , the interventions had no statistically significant effects on actigraph measures , except for potentially improved sleep stability with yoga in women with poor self-reported sleep quality Background Tobacco smoking remains the leading preventable cause of death among American women .  Exercise has shown promise as an aid to smoking cessation because it reduces weight gain and weight concerns , improves affect , and reduces nicotine withdrawal symptoms and cigarette craving . Studies have shown that the practice of yoga improves weight control , and reduces perceived stress and negative affect . Yoga practice also includes regulation of breathing and focused attention , both of which may enhance stress reduction and improve mood and well-being and may improve cessation outcomes . Methods / Design This pilot efficacy study is design ed to examine the  rates of cessation among women r and omized to either a novel , 8-week Yoga plus Cognitive Behavioral Therapy ( CBT ) smoking cessation intervention versus a Wellness program plus the same CBT smoking cessation intervention . Outcome measures include 7-day point prevalence abstinence at end of treatment , 3 and 6 months follow up and potential mediating variables ( e.g. , confidence in quitting smoking , self-efficacy ) . Other assessment s include measures of mindfulness , spirituality , depressive symptoms , anxiety and perceived health ( SF-36 ) . Discussion Innovative treatments are needed that address barriers to successful  smoking cessation among men and women . The design chosen for this study will allow us to explore potential mediators of intervention efficacy so that we may better underst and the mechanism(s ) by which yoga may act as an effective complementary treatment for smoking cessation . If shown to be effective , yoga can offer an alternative to traditional exercise for reducing negative symptoms that often accompany smoking cessation and predict relapse to smoking among recent quitters . Trial Registration Clinical Trials Background Back pain , one of the most prevalent conditions afflicting American adults , is the leading reason for using complementary and alternative medicine ( CAM ) therapies . Yoga is an increasingly popular " mind-body " CAM therapy often used for relieving back pain and several small studies have found yoga effective for this condition . This study will assess whether yoga is effective for treating chronic low back pain compared with self care and exercise and will explore the mechanisms responsible for any observed benefits . Methods / Design A total of 210 participants with low back pain lasting at least 3 months will be recruited from primary care clinics of a large healthcare system based in Seattle . They will be r and omized in a 2:2:1 ratio to receive 12 weekly yoga classes , 12 weekly conventional therapeutic exercise classes of comparable physical exertion , or a self-care book . Interviewers masked to participants ' treatment group will assess outcomes at baseline and 6 , 12 and 26 weeks after r and omization . Primary outcomes will be back-related dysfunction and symptom bothersomeness . In addition , data will be collected on physical measurements ( e.g. , flexion ) at baseline and 12 weeks and saliva sample s will be obtained at baseline , 6 and 12 weeks . Information will be collected on specific physical , psychological , and physiological factors to allow exploration of possible mechanisms of action through which yoga could relieve back pain and dysfunction . The effectiveness of yoga will be assessed using analysis of covariance ( using general estimating equations - GEE ) within an intention-to-treat context . If yoga is found effective , further analyses will explore whether yoga 's benefits are attributable to physical , psychological and /or physiological factors . Conclusions This study will provide the clearest evidence to date about the value of yoga as a therapeutic option for treating  chronic back pain  , and if the results are positive , will help focus future , more in-depth , research on the most promising potential mechanisms of action identified by this study .Trial registration This trial is registered in Clinical Trials.gov , with the ID number of NCT00447668 Hatha-Yoga has become increasingly popular in western countries as a method for coping with stress . However , little is known about the physiological and psychological effects of yoga practice . We measured heart rate , blood pressure , the hormones cortisol , prolactin and growth hormone and certain psychological parameters in a  yoga practicing group and a control group of young female volunteers reading in a comfortable position during the experimental period . There were no substantial differences between the groups concerning endocrine parameters and blood pressure . The course of heart rate was significantly different , the yoga group had a decrease during the yoga practice . Significant differences between both groups were found in psychological parameters . In the personality inventory the yoga group showed markedly higher scores in life satisfaction and lower scores in excitability , aggressiveness , openness , emotionality and somatic complaints . Significant differences could also be observed concerning coping with stress and the mood at the end of the experiment . The yoga group had significant higher scores in high spirits and extravertedness Objective The practice of yoga has been proven to have positive effects on reducing  insomnia . Studies have also shown its effects on reducing climacteric symptoms . To date , however , no studies that evaluate the effects of yoga on postmenopausal women with a diagnosis of insomnia in a r and omized clinical trial have been conducted . The aim of this study was to evaluate the effect of yoga practice on the physical and mental health and climacteric symptoms of postmenopausal women with a diagnosis of insomnia . Methods Postmenopausal women not undergoing hormone therapy , who were 50 to 65 years old , who had an apnea-hypopnea index less than 15 , and who had a diagnosis of insomnia were r and omly assigned to one of three groups , as follows : control , passive stretching , and yoga . Question naires were administered before and 4 months after the intervention to evaluate quality of life , anxiety and depression symptoms , climacteric symptoms , insomnia severity , daytime sleepiness , and stress . The volunteers also underwent polysomnography .  The study lasted 4 months . Results There were 44 volunteers at the end of the study . When compared with the control group , the yoga group had significantly lower posttreatment scores for climacteric symptoms and insomnia severity and higher scores for quality of life and resistance phase of stress . The reduction in insomnia severity in the yoga group was significantly higher than that in the control and passive-stretching groups . Conclusions This study showed that a specific sequence of yoga might be effective in reducing insomnia and menopausal symptoms as well as improving quality of life in postmenopausal women with insomnia Background : Many women experience detriments in mental health during the menopausal transition . Physical activity may attenuate these adverse outcomes but few studies investigating such effects exist . Purpose : This study examined the effects of a 4-month r and omized controlled exercise trial on mental health outcomes in 164 previously low-active middle-aged women ( M age=49.9 ; SD=3.6 ) . Methods and Results : Participants completed body composition and fitness assessment and a battery of psychological measures at the beginning and end of a 4-month r and omized controlled exercise trial with three arms : walking , yoga , control . The results indicated that walking and yoga were effective in enhancing positive affect and menopause-related QOL and reducing negative affect . Women who experienced decreases in menopausal symptoms across the trial also experienced improvements in all positive mental health and QOL outcomes and reductions in negative mental health outcomes . Whether menopausal symptoms increased or decreased across the trial appeared to be determined in part by whether there were increases or decreases in cardiorespiratory fitness . Conclusions : Physical activity appears to enhance mood and menopause-related QOL during menopause , however , other aspects of mental health may be affected only as a result of reduction in menopausal symptoms . Increasing cardiorespiratory fitness could be one way to reduce menopausal symptoms Study Objectives The Menopause Strategies : Finding Lasting Answers for Symptoms and Health network conducted three r and omized clinical trials ( RCTs ) testing six interventions treating vasomotor symptoms ( VMS ) , and also collected self-reported sleep outcomes . A fourth RCT assessed an intervention for insomnia symptoms among women with VMS . We describe these seven interventions ' effects relative to control in women with comparably severe insomnia symptoms and VMS . Methods We analyzed pooled individual-level data from 546 peri- and postmenopausal women with Insomnia Severity Index ( ISI ) ≥ 12 , and ≥14 bothersome VMS/week across the four RCTs . Interventions included the following : escitalopram 10 - 20 mg/day ; yoga ; aerobic exercise ; 1.8 g/day omega-3 fatty acids ; oral 17-beta-estradiol 0.5-mg/day ; venlafaxine XR 75-mg/day ; and cognitive behavioral therapy for insomnia ( CBT-I ) . Outcome measures were ISI and Pittsburgh Sleep Quality Index ( PSQI ) over 8 - 12 weeks of treatment . Results CBT-I produced the greatest reduction in ISI from baseline relative to control at -5.2 points ( 95 % CI -7.0 to -3.4 ) . Effects on ISI were similar for exercise at -2.1 and venlafaxine at -2.3 points . Comparably small decreases in ISI were observed with escitalopram , yoga , and estradiol . The largest reduction in PSQI from baseline was with CBT-I at -2.7 points ( -3.9 to -1.5 ) , although PSQI decreases of 1.2 to 1.6 points were significantly better than control with escitalopram , exercise , yoga , estradiol , and venlafaxine . Omega-3 supplements did not improve insomnia symptoms . Conclusions This study 's findings support current recommendations for CBT-I as a first line treatment in healthy midlife women with insomnia symptoms and moderately bothersome VMS OBJECTIVES The purpose of the study was to investigate the effects of a 12-week yoga program on heart rate variability ( HRV ) and depressive symptoms in depressed women . METHODS This was a r and omized controlled trial . Twenty-six sedentary women scoring ≥14 on the Beck Depression Inventory-II were r and omized to either the yoga or the control group . The yoga group completed a 12-week yoga program , which took place twice a week for 60 min per session and consisted of breathing exercises , yoga pose practice , and supine meditation/relaxation . The control group was instructed not to engage in any yoga practice and to maintain their usual level of physical activity during the course of the study .  Participants ' HRV , depressive symptoms , and perceived stress were assessed at baseline and post-test . RESULTS The yoga group had a significant increase in high-frequency HRV and decreases in low-frequency HRV and low frequency/high frequency ratio after the intervention . The yoga group also reported significantly reduced depressive symptoms and perceived stress . No change was found in the control group . CONCLUSIONS A 12-week yoga program was effective in increasing parasympathetic tone and reducing depressive symptoms and perceived stress in women with elevated depressive symptoms .  Regular yoga practice may be recommended for women to cope with their depressive symptoms and stress and to improve their HRV BACKGROUND Tobacco smoking remains the leading preventable cause of death among American women .  Aerobic exercise has shown promise as an aid to smoking cessation because it improves affect and reduces nicotine withdrawal symptoms . Studies outside the realm of smoking cessation have shown that yoga practice also reduces perceived stress and negative affect . METHODS This pilot study examines the feasibility and initial efficacy of yoga as a complementary therapy for smoking cessation .  Fifty-five women were given 8-week group-based cognitive behavioral therapy for smoking cessation and were r and omized to a twice-weekly program of Vinyasa yoga or a general health and wellness program ( contact control ) . The primary outcome measure was 7-day point prevalence abstinence at the end of treatment vali date d by saliva cotinine testing . Longitudinal analyses were also conducted to examine the effect of intervention on smoking cessation at 3- and 6-month follow-up . We examined the effects of the intervention on potential mediating variables ( e.g. , confidence in quitting smoking , self-efficacy ) , as well as measures of depressive symptoms , anxiety , and perceived health ( SF-36 ) . RESULTS At end of treatment , women in the yoga group had a greater 7-day point-prevalence abstinence rate than controls ( odds ratio [ OR ] , 4.56 ; 95 % CI , 1.1 - 18.6 ) . Abstinence remained higher among yoga participants through the six month assessment ( OR , 1.54 ; 95 % CI , 0.34 - 6.92 ) , although differences were no longer statistically significant . Women participating in the yoga program also showed reduced anxiety and improvements in perceived health and well-being when compared with controls . CONCLUSIONS Yoga may be an efficacious complementary therapy for smoking cessation among women Ayurveda is derived from 2 Sanskrit words , namely , " Ayus " and " Veda , " meaning life and knowledge , respectively . It literally means science of life . Ayurveda , of which yoga is an integral part , is widely practice d in India and is gaining acceptance in many countries around the world . It is a comprehensive and a holistic system , the focus of which is on the body , mind , and consciousness . The Ayurvedic treatment consists of the use herbal preparations , diet , yoga , meditation , and other practice s. Based on the review of available studies , the evidence is not convincing that any Ayurvedic herbal treatment is effective in the treatment of heart disease or hypertension . However , the use of certain spices and herbs such as garlic and turmeric in an overall healthy diet is appropriate . Many herbs used by Ayurvedic practitioners show promise and could be appropriate for larger r and omized trials . Yoga , an integral part of Ayurveda , has been shown to be useful to patients with heart disease and hypertension .  Yoga  reduces anxiety , promotes well-being , and improves quality of life . Its safety profile is excellent . Its use as a complementary therapeutic regimen under medical supervision is appropriate and could be worth considering OBJECTIVE To determine the feasibility and acceptability of a restorative yoga intervention for the treatment of hot flushes in postmenopausal women . METHODS A pilot trial in 14 postmenopausal women experiencing > or = 4 moderate to severe hot flushes per day or > or = 30 moderate to severe hot flushes per week . The intervention consisted of eight restorative yoga poses taught in a 3-h introductory session and 8 weekly 90-min sessions .  Feasibility was measured by recruitment rates , subject retention and adherence . Acceptability was assessed by subject interview and question naires . Efficacy measures included change in frequency and severity of hot flushes as recorded on a 7-day diary . RESULTS Recruitment was accomplished as planned . The majority of study subjects ( 93 % ) completed the trial . Of those who completed the trial , 92 % attended seven or more of the eight yoga sessions . The majority of the subjects were satisfied with the study and 75 % continued to practice yoga 3 months after the study . Mean number of hot flushes per week decreased by 30.8 % ( 95 % CI 15.6 - 45.9 % ) and mean hot flush score decreased 34.2 % ( 95 % CI 16.0 - 52.5 % ) from baseline to week 8 . No adverse events were observed . CONCLUSIONS This pilot trial demonstrates that it is feasible to teach restorative yoga to middle-aged women without prior yoga experience . The high rates of subject retention and satisfaction suggest that yoga is an acceptable intervention in this population . Our results indicate that a larger , r and omized controlled trial to explore the efficacy of restorative yoga for treatment of menopausal symptoms would be safe and feasible Posttraumatic stress disorder ( PTSD ) is a debilitating condition that affects approximately 10 % of women in the United States . Although effective psychotherapeutic treatments for PTSD exist , clients with PTSD report additional benefits of complementary and alternative approaches such as yoga . In particular , yoga may downregulate the stress response and positively impact PTSD and comorbid depression and anxiety symptoms . We conducted a pilot study of a r and omized controlled trial comparing a 12-session Kripalu-based yoga intervention with an assessment control group .  Participants included 38 women with current full or subthreshold PTSD symptoms . During the intervention , yoga participants showed decreases in reexperiencing and hyperarousal symptoms . The assessment control group , however , showed decreases in reexperiencing and anxiety symptoms as well , which may be a result of the positive effect of self-monitoring on PTSD and associated symptoms . Between-groups effect sizes were small to moderate ( 0.08 - 0.31 ) . Although more research is needed , yoga may be an effective adjunctive treatment for PTSD . Participants responded positively to the intervention , suggesting that it was tolerable for this sample . Findings underscore the need for future research investigating mechanisms by which yoga may impact mental health symptoms , gender comparisons , and the long-term effects of yoga practice Background : The ancient mind and body healing methods of yoga recently sparked fervor in the scientific community as an alternative and complementary means of therapy . Since the World Health Organization officially began promoting yoga in developing countries in 1978 , yoga has been cited for its therapeutic potential and has been widely recognized in Western culture . However , as an increasing number of people practice yoga for remedial purpose s , research ers raise two important questions : 1 ) Is yoga a valid complementary management and rehabilitation treatment modality ? 2 ) What conditions show promise of treatment with this intervention ? . Objective : This review article uses comprehensive scientific , evidence -based studies to analyze the efficacy of various basic and applied aspects of yoga in disease prevention and health promotion . It specifically intends to expose the effects of yoga in neurological disorders , particularly epilepsy , stroke , multiple sclerosis , Alzheimer 's disease , peripheral nervous system disease , and fibromyalgia . Material s and Methods : Information was gathered from various re sources including PubMed , Ovid , MD-Consult , USC , and U.C.L.A. libraries . Studies were selected and review ed on the basis of sample size , control , r and omization , double-blinding , and statistical analysis of results . Results : The pratice of yoga and meditation demonstrates statistically encouraging physiological and psychological improvements in the aforementioned neurological disorders . However , there were certain flaws and inadequacies in the study design s employed to evaluate the same . A critical analysis of these studies is presented . Conclusions : With the aim to focus attention on this widespread yet largely unexamined treatment modality , this paper seeks to provide direction and support for further research necessary to vali date yoga as an integrative , alternative , and complementary therapy Context Caution about taking estrogen for treating  postmenopausal vasomotor symptoms has led to increasing substitution of herbal regimens despite few tests of their effectiveness . Contribution The authors r and omly assigned 351 perimenopausal or postmenopausal women to herbal treatments ( black cohosh , multibotanicals , or multibotanicals plus counseling about dietary soy ) , estrogen with or without progesterone , or placebo . At 3 , 6 , and 12 months , patients receiving the herbal interventions had the same change in vasomotor symptoms as those receiving placebo ( except for more severe symptoms at 12 months for patients taking multibotanicals plus dietary soy ) . Estrogen substantially decreased vasomotor symptoms . Caution s Most participants were white and were well-educated . Implication s Herbal regimens did not reduce postmenopausal vasomotor symptoms in this sample of women . The Editors Hormone therapy remains the recommended treatment for vasomotor symptoms , but trials have shown serious risks with even short-term use ( 1 , 2 ) . The use of herbs , particularly black cohosh , multibotanical supplements , and dietary soy for menopausal symptoms has grown dramatically ( 36 ) . Few of these approaches have been scientifically evaluated . Women and providers are seeking safe , effective alternatives to hormone therapy . We design ed the Herbal Alternatives for Menopause Trial ( HALT ) to provide rigorous evidence on the efficacy and short-term safety of commonly used naturopathic approaches for management of vasomotor symptoms . Methods Design Overview and Setting HALT was a 1-year double-blind , r and omized , controlled trial design ed to investigate the effects of 3 naturopathic approaches for  vasomotor symptom relief and hormone therapy compared with placebo . Study methods have been described elsewhere ( 7 ) . The Group Health Institutional Review Board approved this study , and a data and safety monitoring committee monitored it . The study was conducted at Group Health , an integrated health plan in Washington State . Participants Eligibility criteria were as follows : age 45 to 55 years ; late menopausal transition ( 1 skipped menses within the preceding 12 months ) or postmenopausal ( no bleeding within 12 months , or follicle-stimulating hormone level > 20 IU/mL if patient had undergone hysterectomy without bilateral oophorectomy ) ; and 2 or more vasomotor symptoms per day over 2 weeks ( 6 moderate to severe symptoms ) . Women in menopausal transition were included because many are highly symptomatic and trial data are lacking for this group . Exclusion criteria were the following : contraindications to hormone therapy ; use of hormone therapy or oral contraceptives within 3 months before the trial ; use of herbal medicines for menopausal symptoms within 1 month before the trial ; soy allergy ; bilateral oophorectomy ; history of breast cancer ; and nonadherence during the run-in period ( < 80 % of capsules taken ) . From May 2001 through August 2003 , women were recruited by using direct mail . Screening calls determined initial eligibility . Women attended an orientation visit at which eligibility was confirmed , physical measurements were collected , and placebo medication and question naires for the 2-week run-in period were provided . R and omization and Interventions Participants were r and omly assigned by using SAS software ( SAS Institute , Inc. , Cary , North Carolina ) , stratified by previous hormone therapy and hysterectomy ; block sizes within strata ranged from 5 to 25 . Treatment assignments were sent to the University of Washington Research Pharmacy , where medications were bottled and labeled with a sequential identification number without treatment group indication . At the r and omization visit , vasomotor symptom diaries and medication counts were examined to confirm eligibility and adherence . The study nurse determined the appropriate stratum , assigned the participant the next study number in that stratum without knowledge of group assignment , and distributed study medications . The publication of results from the Women 's Health Initiative ( WHI ) estrogenprogestin trial ( 2 ) raised new concerns about the safety of estrogen therapy . New study participants were given the choice of 5-arm ( including hormone therapy ) versus 4-arm ( no hormone therapy ) r and omization . Current participants gave consent again , incorporating risk estimates from the WHI , and were given the option of finding out whether they had been assigned to hormone therapy ; 16 were unblinded , 1 discontinued use of the study drug , and all remained enrolled . Following publication of the WHI Memory Study ( 8 , 9 ) , we informed participants of those findings and restricted r and omization to herbs and placebo . No further women were unblinded or discontinued use of the study drug . Naturopathic medicine provided the model for study interventions . The herbal products , doses , and soy diet were based on approaches used by naturopaths when the study was design ed ( 7 ) . The study groups were as follows : 1 ) black cohosh  ( Actaea racemosa or Cimicifuga racemosa , 160 mg daily ; 2.5 % triterpene glycosides ; 70 % ethanol extract ) ; 2 )  multibotanical ;  3 )  multibotanical plus soy diet counseling ; 4 ) conjugated equine estrogen , 0.625 mg daily , with ( for women with a uterus ) or without ( for women without a uterus ) medroxyprogesterone acetate , 2.5 mg ; and 5 ) placebo . The multibotanical delivered daily doses of the following : black cohosh , 200 mg ; alfalfa ( Medicago sativa ) , 400 mg ; boron , 4 mg ; chaste tree ( Vitex agnus-castus ) , 200 mg ; dong quai ( Angelica sinensis ) , 400 mg ; false unicorn ( Chamaelirium luteum ) , 200 mg ; licorice ( Glycyrrhiza glabra ) , 200 mg ; oats ( Avena sativa ) , 400 mg ; pomegranate ( Punica granatum ) , 400 mg ; Siberian ginseng ( Eleutherococcus senticosus , st and ardized constituents 0.8 % eleutherosides E and B ) , 400 mg . Black cohosh was provided by Pure World , Inc. , ( Hackensack , New Jersey ) . The multibotanical , ProGyne , was purchased from Progena Professional Formulations ( Albuquerque , New Mexico ) and encapsulated to study specifications . Both companies follow current good manufacturing practice s , and single batches were used . ConsumerLab.com ( White Plains , New York ) tested the products after the study commenced . Dong quai , false unicorn , and pomegranate were not detected , suggesting that they were of poor quality or did not contain the tested marker compounds . Other marker compounds were detected in the approximate doses as labeled ( 7 ) . The Appendix Table describes the herbal products in detail . Appendix Table . Consoli date d St and ards of Reporting Trials ( CONSORT ) Requirements for Controlled Trials of Herbal Interventions To facilitate blinding , medications and lactose placebo were encapsulated to provide 2 white and 2 blue capsules to each woman , and medication boxes were labeled with a unique identification number that did not indicate study group . The soy food intervention was modeled after a successful 5-a-day intervention ( 10 ) . We chose soy foods because of uncertainty about the efficacy of isoflavone supplements and because naturopaths commonly recommend whole soy foods . Participants received 5 telephone calls from a clinical dietitian and a 34-page booklet recommending 2 soy food servings per day ( 12 to 20 g of soy protein ) ( 7 ) . Other participants received 1 telephone call and a similar booklet reinforcing fruit and vegetable intake . Participants were instructed not to discuss dietitian calls with study nurses and were unaware that soy counseling was linked to the multibotanical . Outcomes and Measurements The primary outcomes were change from baseline ( measured over 2-week run-in period ) to 3 , 6 , and 12 months ( each measured for 4 weeks ) and change from baseline to the average for all follow-ups with regard to the mean frequency and intensity of vasomotor symptoms ( daytime hot flashes plus night sweats ) and the mean Wiklund Vasomotor Symptom Subscale score ( 11 , 12 ) . We also evaluated change from baseline to follow-up ( months 3 , 6 , and 12 and average change ) for daytime hot flash rate , night sweat rate , and the total Wiklund Menopause Symptom Scale score . Symptom diaries and global ratings of menopause symptoms are almost universally used in studies of vasomotor symptoms . Participants used a  vasomotor symptom diary  to record daytime hot flashes and night sweats , rating intensity as mild , moderate , or severe ( scale , 1 to 3 ) , as recommended by the U.S. Food and Drug Administration ( 13 ) . Women completed the Wiklund Menopause Symptom Scale , rating the severity of 13 menopausal symptoms ( sweats , hot flashes , sleep disturbance , fatigue , vaginal dryness , depression , headache , irritability , muscle/joint pain , breast tenderness , nervousness , palpitations , and dizziness/fainting on a scale of 0 ( none ) to 10 ( severe ) ( 11 ) . Soy food intake was monitored by using a self-reported , vali date d soy food question naire ( 14 ) . Follow-up Procedures Participants returned to the research clinic at 3 , 6 , and 12 months . Question naires were collected , and study medication was dispensed . Medication adherence counts were conducted by staff without participant contact and without knowledge of treatment assignment . Study nurses encouraged adherence and monitored adverse events during monthly telephone calls and at visits . Adverse events were identified through participants ' responses to the question , Have you had any medical problems or been hospitalized ? Responses were recorded and adverse events were followed until they were resolved . The study nurse determined intensity ( mild , moderate , or severe ) and whether the event was serious ( yes or no ) . Events were review ed by the study physician , who determined whether the event was study related , without knowledge of group assignment . Adverse events were coded by using the Coding Symbols for Thesaurus of Adverse Reaction Terms ( 15 ) . The Data and Safety Monitoring Committee review ed study progress and unblinded outcome and safety data 5 times . Statistical Analysis The study was powered to detect an effect of Objective : Many middle-aged women experience decreases in their sleep quality during the menopausal transition . Physical activity has been shown to improve sleep , but few r and omized , controlled trials investigating such effects in this population exist . In 164 previously low-active middle-aged women ( mean age = 49.9 , SD = 3.6 ) , using a 4-month r and omized , controlled trial , we examined structured exercise in the form of walking or yoga to determine the effects on perceived sleep quality . Design : Participants completed body composition and fitness assessment s and a battery of psychological measures , including the Pittsburgh Sleep Quality Index , at the beginning and end of a 4-month r and omized , controlled exercise trial with three arms : walking , yoga , and control . Results : A series of mixed-model repeated- measures univariate analyses of covariance did not reveal any statistically significant intervention effects for total sleep quality or any individual sleep- quality domain . The pattern of effect sizes indicated that the walking group tended to experience small improvements in five of the seven assessed sleep- quality domains . Residual changes in menopausal symptoms and depression were associated with residual changes in total sleep quality . However , after controlling for the effects of physical activity , only menopausal symptoms contributed a unique amount of variance in residual change in total sleep quality . Conclusions : In this study , 4-month moderate-intensity walking and low-intensity yoga programs were ineffective in yielding statistically significant improvements in sleep quality .  Exercise interventions of longer duration s or greater intensity may be needed for such improvements Context Yoga combines exercise with achieving a state of mental focus through breathing . In the United States , 1 million people practice yoga for low back pain . Contribution The authors recruited patients who had a recent primary care visit for low back pain and r and omly assigned 101 to yoga or conventional exercise or a self-care book . Patients in the yoga and exercise groups reported good adherence at 26 weeks . Compared with self-care , symptoms were milder and function was better with yoga . The exercise group had intermediate outcomes . Symptoms improved between 12 and 26 weeks only with yoga . Implication s Yoga was a more effective treatment for low back pain than a self-care book . The Editors Most treatments for chronic low back pain have modest efficacy at best ( 1 ) . Exercise is one of the few proven treatments for chronic low back pain ; however , its effects are often small , and no form has been shown to be clearly better than another ( 2 - 5 ) . Yoga , which often couples physical exercise with breathing , is a popular alternative form of mindbody therapy . An estimated 14 million Americans practice d yoga in 2002 ( 6 ) , including more than 1 million who used it as a treatment for back pain ( 7 , 8) . Yoga may benefit patients with back pain simply because it involves exercise or because of its effects on mental focus . We found no published studies in western biomedical literature that evaluated yoga for chronic low back pain ; therefore , we design ed a clinical trial to evaluate its effectiveness and safety for this condition . Methods Study Design and Setting This r and omized , controlled trial compared the effects of yoga classes with conventional exercise classes and with a self-care book in patients with low back pain  that persisted for at least 12 weeks . The study was conducted at Group Health Cooperative , a nonprofit , integrated health care system with approximately 500000 enrollees in Washington State and Idaho . The Group Health Cooperative institutional review board approved the study protocol , and all study participants gave oral informed consent before the eligibility screening and written consent before the baseline interview and r and omization . Patients Patients from Group Health Cooperative were recruited for 12-week sessions of classes that were conducted between June and December 2003 . We mailed letters describing the study to 6913 patients between 20 and 64 years of age who had visited a primary care provider for treatment of back pain 3 to 15 months before the study ( according to electronic visit records ) . We also advertised the study in the health plan 's consumer magazine . Patients were informed that we were comparing 3 approaches for the relief of back pain and that each was design ed to help reduce the negative effects of low back pain on people 's lives . A research assistant telephoned patients who returned statements of interest to assess their eligibility . After we received their signed informed consent forms , eligible patients were telephoned again for collection of baseline data and r and omization to treatment . We excluded individuals whose back pain was complicated ( for example , sciatica , previous back surgery , or diagnosed spinal stenosis ) , potentially attributable to specific underlying diseases or conditions ( for example , pregnancy , metastatic cancer , spondylolisthesis , fractured bones , or dislocated joints ) , or minimal ( rating of less than 3 on a bothersomeness scale of 0 to 10 ) . We also excluded individuals who were currently receiving other back pain treatments or had participated in yoga or exercise training for back pain in the past year , those with a possible disincentive to improve ( such as patients receiving workers ' compensation or those involved in litigation ) , and those with unstable medical or severe psychiatric conditions or dementia . Patients who had contraindications ( for example , symptoms consistent with severe disk disease ) or schedules that precluded class participation , those who were unwilling to practice at home , or those who could not speak or underst and English were also excluded . R and omization Protocol Participants were r and omly assigned to participate in yoga or exercise classes or to receive the self-care book . We r and omly generated treatment assignments for each class series by using a computer program with block sizes of 6 or 9 . A research er who was not involved in patient recruitment or r and omization placed the assignments in opaque , sequentially numbered envelopes , which were stored in a locked filing cabinet until needed for r and omization . Interventions The yoga and exercise classes developed specifically for this study consisted of 12 weekly 75-minute classes design ed to benefit people with chronic low back pain . In addition to attending classes held at Group Health facilities , participants were asked to practice daily at home . Participants received h and outs that described home practice s , and yoga participants received auditory compact discs to guide them through the sequence of postures with the appropriate mental focus ( examples of postures are shown in the Appendix Figure ) . Study participants retained access to all medical care provided by their insurance plan . Appendix Figure . Yoga postures Yoga We chose to use viniyoga , a therapeutically oriented style of yoga that emphasizes safety and is relatively easy to learn . Our class instructor and a senior teacher of viniyoga , who has + written a book about its therapeutic uses ( 9 ) , design ed the yoga intervention for patients with back pain who did not have previous yoga experience . Although all the sessions emphasized use of postures and breathing for managing low back symptoms , each had a specific focus : relaxation ; strength-building , flexibility , and large-muscle movement ; asymmetric poses ; strengthening the hip muscles ; lateral bending ; integration ; and customizing a personal practice . The postures were selected from a core of 17 relatively simple postures , some with adaptations ( Appendix Table ) , and the sequence of the postures in each class was performed according to the rudiments of viniyoga ( 9 ) . Each class included a question - and -answer period , an initial and final breathing exercise , 5 to 12 postures , and a guided deep relaxation . Most postures were not held but were repeated 3 or 6 times . Exercise Because we could not identify a clearly superior form of therapeutic exercise for low back pain from the literature , a physical therapist design ed a 12-session class series that was 1 ) different from what most participants would have probably experienced in previous physical therapy sessions ( to maximize adherence ) and 2 ) similar to the yoga classes in number and length . We included a short educational talk that provided information on proper body mechanics , the benefits of exercise and realistic goal setting , and overcoming common barriers to developing an exercise routine ( for example , fear ) . Each session began with the educational talk ; feedback from the previous week ; simple warm-ups to increase heart rate ; and repetitions of a series of 7 aerobic exercises and 10 strengthening exercises that emphasized leg , hip , abdominal , and back muscles . Over the course of the 12-week series , the number of repetitions of each aerobic and strength exercise increased from 8 to 30 in increments of 2 . The strengthening exercises were followed by 12 stretches for the same muscle groups ; each stretch was held for 30 seconds . Classes ended with a short , unguided period of deep , slow breathing . Self-Care Book Participants were mailed a copy of The Back Pain Helpbook ( 10 ) , an evidence -based book that emphasized such self-care strategies as adoption of a comprehensive fitness and strength program , appropriate lifestyle modification , and guidelines for managing flare-ups . Although we did not provide any instructions for using the book , many of the chapters concluded with specific action items . Outcome Measures Interviewers who were masked to the treatment assignments conducted telephone interviews at baseline and at 6 , 12 , and 26 weeks after r and omization . The baseline interview collected information regarding sociodemographic characteristics , back pain history , and the participant 's level of knowledge about yoga and exercise . Participants were asked to describe their current pain and to rate their expectations for each intervention . The primary outcomes were back-related dysfunction and symptoms , and the primary time point of interest was 12 weeks . We used the modified Rol and Disability Scale ( 11 ) to measure patient dysfunction by totaling the number of positive responses to 23 questions about limitations of daily activities that might arise from back pain . This scale has been found to be valid , reliable , and sensitive to change ( 12 - 14 ) ; research ers estimate that the minimum clinical ly significant difference on the Rol and scale ranges from 2 to 3 points ( 13 , 15 ) . Participants rated how bothersome their back pain had been during the previous week on an 11-point scale , in which 0 represented not at all bothersome and 10 represented extremely bothersome ; a similar measure demonstrated substantial construct validity in earlier research ( 13 ) . Estimates of the minimum clinical ly significant difference on the bothersomeness scale were approximately 1.5 points ( 16 , 17 ) . Secondary outcome measures were general health status , which we assessed by conducting the Short Form-36 Health Survey ( 18 ) ; degree of restricted activity as determined by patient responses to 3 questions ( 19 ) ; and medication use . After all outcomes data were collected , we asked questions related to specific interventions ( for example , Did you practice at home ? ) . At the 12-week interview , we asked class participants about any pain or substantial discomfort they experienced as a result of the classes . We assessed adherence to the home practice recommendations by asking class participants to complete weekly home practice logs and by asking about home practice during the follow-up Hypertension is a major public health issue affecting 68 million adults in the United States . Lifestyle modifications including complementary therapies such as the movement based mind body practice of yoga have become increasingly popular in the United States and have been considered as a potential alternative to medication in blood pressure reduction . We completed a pilot study in 2009 which showed meaningful decreases in 24-hour ambulatory blood pressure readings after a 12 week period of yoga participation . Based on data from our pilot study we are now completing The Lifestyle Modification and Blood Pressure Study ( LIMBS II ) which is a phase 2 r and omized controlled trial design ed to determine the effects of yoga therapy and enhanced lifestyle modification on lowering blood pressure in pre-hypertensive and stage 1 hypertensive subjects . Using 24-hour ambulatory blood pressure monitoring , LIMBS II aims to compare the effects on blood pressure reduction in subjects r and omized for 24 weeks to one of the three following groups : yoga therapy versus blood pressure education program ( sodium restriction and walking program ) versus a combination program that involves components of both groups . LIMBS II will also examine the impact that changes in blood pressure have on cerebral blood flow . If successful , the LIMBS study will determine if yoga therapy combined with enhanced lifestyle modification will result in clinical ly meaningful decreases in blood pressure and thus can be implemented as an alternative to drug therapy for patients with prehypertension and stage 1 hypertension
A recent cross-sectional analysis in the multiethnic Study of Women ’s Health Across the Nation found that 53 % of the participants used some form of CAM ( excluding diet , vitamins , exercise , and prayer ) and that rates of use generally did not vary by menopausal status or by presence of vasomotor symptoms .
Significant improvements were also found in sleep quality ( P = 0.02 ) and
I n the wake of serious health concerns raised by the Women ’s Health Initiative and Heart and Estrogen/ progestin Replacement Study clinical trials , prescriptions for hormone therapy have declined dramatically , leaving many women without effective treatment for menopausal symptoms .
Several nonhormonal pharmacologic therapies have shown promise for reducing vasomotor symptoms , including selective serotonin reuptake inhibitors , gabapentin , and clonidine .
However , most are only modestly effective , and all have side effects that may limit their use .
A number of herbal therapies are marketed to women as being safe and effective in reducing menopausal symptoms , including phytoestrogens , black cohosh , dong quai , evening primrose oil , and red clover .
Still , interest in nonhormonal and particularly in complementary and alternative medicine ( CAM ) therapies for menopausal symptoms remains strong .
The term yoga is derived from the Sanskrit term yuj , meaning Bto yoke^ or Bto unite,^ and the goal of yoga has been described as uniting the body and mind to achieve enlightenment .
Yoga has become increasingly popular outside of India , with a 2008 survey of 5,050 people estimating that 7 % of US adults practice yoga .
Clinical trials have also demonstrated many potential health benefits of yoga , including reductions in blood pressure , dyslipidemia , and insulin resistance .
Although the exact mechanisms of hot flashes remain unknown , physiologic studies have demonstrated that heightened sympathetic nervous system activity plays an important role .
Small uncontrolled studies have shown that yoga increases heart rate variability and decreases oxygen consumption , heart rate , and blood pressure , all indicative of decreased sympathetic activity .
In addition to its biological effects , yoga may also have beneficial psychological effects that could lead women to find physical symptoms less bothersome and /or help them to cope better with changes during menopause .
In this issue of Menopause , Chattha and colleagues report results from one of the largest published trials of yoga for menopausal symptoms .
Despite the increasing popularity of yoga , a yoga intervention requiring 60 minutes of supervised instruction five times per week may not be practical for many Western women .