Pamela E Jeter

A systematic review of yoga for balance in a healthy population

OBJECTIVE A systematic review was done of the evidence on yoga for improving balance. DESIGN Relevant articles and reviews were identified in major databases (PubMed, MEDLINE(®), IndMed, Web of Knowledge, EMBASE, EBSCO, Science Direct, and Google Scholar), and their reference lists searched. Key search words were yoga, balance, proprioception, falling, fear of falling, and falls. Included studies were peer-reviewed articles published in English before June 2012, using healthy populations. All yoga styles and study designs were included. Two (2) raters individually rated study quality using the Downs & Black (DB) checklist. Final scores were achieved by consensus. Achievable scores ranged from 0 to 27. Effect size (ES) was calculated where possible. RESULTS Fifteen (15) of 152 studies (age range 10-93, n=688) met the inclusion criteria: 5 randomized controlled trials (RCTs), 4 quasi-experimental, 2 cross-sectional, and 4 single-group designs. DB scores ranged from 10 to 24 (RCTs), 14-19 (quasi-experimental), 6-12 (cross-sectional), and 11-20 (single group). Studies varied by yoga style, frequency of practice, and duration. Eleven (11) studies found positive results (p<0.05) on at least one balance outcome. ES ranged from -0.765 to 2.71 (for 8 studies) and was not associated with DB score. CONCLUSIONS Yoga may have a beneficial effect on balance, but variable study design and poor reporting quality obscure the results. Balance as an outcome is underutilized, and more probing measures are needed.

Ashtanga-Based Yoga Therapy Increases the Sensory Contribution to Postural Stability in Visually-Impaired Persons at Risk for Falls as Measured by the Wii Balance Board: A Pilot Randomized Controlled Trial

Objective Persons with visual impairment (VI) are at greater risk for falls due to irreparable damage to visual sensory input contributing to balance. Targeted training may significantly improve postural stability by strengthening the remaining sensory systems. Here, we evaluate the Ashtanga-based Yoga Therapy (AYT) program as a multi-sensory behavioral intervention to develop postural stability in VI. Design A randomized, waitlist-controlled, single-blind clinical trial Methods The trial was conducted between October 2012 and December 2013. Twenty-one legally blind participants were randomized to an 8-week AYT program (n = 11, mean (SD) age = 55(17)) or waitlist control (n=10, mean (SD) age = 55(10)). AYT subjects convened for one group session at a local yoga studio with an instructor and two individual home-based practice sessions per week for a total of 8 weeks. Subjects completed outcome measures at baseline and post-8 weeks of AYT. The primary outcome, absolute Center of Pressure (COP), was derived from the Wii Balance Board (WBB), a standalone posturography device, in 4 sensory conditions: firm surface, eyes open (EO); firm surface, eyes closed (EC); foam surface, EO; and foam surface, EC. Stabilization Indices (SI) were computed from COP measures to determine the relative visual (SIfirm, SIfoam), somatosensory (SIEO, SIEC) and vestibular (SIV, i.e., FoamEC vs. FirmEO) contributions to balance. This study was not powered to detect between group differences, so significance of pre-post changes was assessed by paired samples t-tests within each group. Results Groups were equivalent at baseline (all p > 0.05). In the AYT group, absolute COP significantly increased in the FoamEO (t(8) = -3.66, p = 0.01) and FoamEC (t(8) = -3.90, p = 0.01) conditions. Relative somatosensory SIEO (t(8) = -2.42, p = 0.04) and SIEC (t(8) = -3.96, p = 0.01), and vestibular SIV (t(8) = -2.47, p = 0.04) contributions to balance increased significantly. As expected, no significant changes from EO to EC conditions were found indicating an absence of visual dependency in VI. No significant pre-post changes were observed in the control group (all p > 0.05). Conclusions These preliminary results establish the potential for AYT training to develop the remaining somatosensory and vestibular responses used to optimize postural stability in a VI population. Trial Registration www.ClinicalTrials.gov NCT01366677

Intra-session test-retest reliability of magnitude and structure of center of pressure from the Nintendo Wii Balance Board™ for a visually impaired and normally sighted population

Individuals with visual impairment (VI) have irreparable damage to one of the input streams contributing to postural stability. Here, we evaluated the intra-session test-retest reliability of the Wii Balance Board (WBB) for measuring Center of Pressure (COP) magnitude and structure, i.e. approximate entropy (ApEn) in fourteen legally blind participants and 21 participants with corrected-to-normal vision. Participants completed a validated balance protocol which included four sensory conditions: double-leg standing on a firm surface with eyes open (EO-firm); a firm surface with eyes closed (EC-firm); a foam surface with EO (EO-foam); and a foam surface with EC (EC-foam). Participants performed the full balance protocol twice during the session, separated by a period of 15min, to determine the intraclass correlation coefficient (ICC). Absolute reliability was determined by the standard error of measurement (SEM). The minimal difference (MD) was estimated to determine clinical significance for future studies. COP measures were derived from data sent by the WBB to a laptop via Bluetooth. COP scores increased with the difficulty of sensory condition indicating WBB sensitivity (all p<0.01). ICCs in the VI group ranged from 0.73 to 0.95, indicating high to very high correlations, and the normal group showed moderate to very high ICCs (0.62-0.94). The SEM was comparable between groups regardless of between-subject variability. The reliability of the WBB makes it practical to screen for balance impairment among VI persons.

The importance of research literacy for yoga therapists

Evidence-Informed Practice (EIP) utilizes the three components of expert opinion, research evidence, and client values. It is a recommended training competency for integrative health practitioners in diverse fields, such as acupuncture and massage therapy. Research Literacy (RL) is a necessary pre-requisite to EIP. Many yoga therapists have limited training in these skills, which negatively impacts inter-professional communication and collaboration, as well as further advancement of yoga therapy research and practice. In this article, we propose inclusion of RL and EIP in the training of yoga therapists. Benefits for client care, collaborative care, and the field of yoga therapy are discussed.

P05.48. Yoga for Police Academy recruits

Purpose Law enforcement ranks as one of the most stressful occupations in the world. Police Academy training does not prepare recruits to handle chronic occupational stress, which is known to lead to adverse health outcomes, such as depression and maladaptive behaviors. Yoga is a mind-body practice composed of postures, breathing, and meditation techniques and is known for its beneficial effects on stress and mood disturbances. The present feasibility study evaluated the effects of a Kripalu Yoga program on perceived stress, mood, and mindfulness during police academy recruit training.