Yoga for Multiple Sclerosis: A Systematic Review and Meta-Analysis
Citation: Cramer H, Lauche R, Azizi H, Dobos G, Langhorst J (
Yoga for Multiple Sclerosis: A Systematic Review and Meta-Analysis
Holger Cramer 0
Romy Lauche 0
Hoda Azizi 0
Gustav Dobos 0
Jost Langhorst 0
Lamberto Manzoli, University of Chieti, Italy
0 1 Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen , Essen, Germany , 2 Department of Complementary Medicine, Mashhad University of Medical Sciences , Mashhad , Iran
While yoga seems to be effective in a number of neuropsychiatric disorders, the evidence of efficacy in multiple sclerosis remains unclear. The aim of this review was to systematically assess and meta-analyze the available data on efficacy and safety of yoga in patients with multiple sclerosis. Medline/PubMed, Scopus, the Cochrane Central Register of Controlled Trials, PsycINFO, CAM-Quest, CAMbase, and IndMED were searched through March 2014. Randomized controlled trials (RCTs) of yoga for patients with multiple sclerosis were included if they assessed health-related quality of life, fatigue, and/or mobility. Mood, cognitive function, and safety were defined as secondary outcome measures. Risk of bias was assessed using the Cochrane tool. Seven RCTs with a total of 670 patients were included. Evidence for short-term effects of yoga compared to usual care were found for fatigue (standardized mean difference [SMD] = 20.52; 95% confidence intervals (CI) = 21.02 to 20.02; p = 0.04; heterogeneity: I2 = 60%; Chi2 = 7.43; p = 0.06) and mood (SMD = 20.55; 95%CI = 20.96 to 20.13; p = 0.01; heterogeneity: I2 = 0%; Chi2 = 1.25; p = 0.53), but not for health-related quality of life, muscle function, or cognitive function. The effects on fatigue and mood were not robust against bias. No short-term or longer term effects of yoga compared to exercise were found. Yoga was not associated with serious adverse events. In conclusion, since no methodological sound evidence was found, no recommendation can be made regarding yoga as a routine intervention for patients with multiple sclerosis. Yoga might be considered a treatment option for patients who are not adherent to recommended exercise regimens.
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Data Availability: The authors confirm that all data underlying the findings are fully available without restriction. Data are available from the published RCTs
from which they were extracted.
Competing Interests: The authors have declared that no competing interests exist.
Introduction
Multiple sclerosis is the most common chronic autoimmune
inflammatory disease of the central nervous system and the leading
cause of disability in young adults [1,2]. Multiple sclerosis is
mainly characterized by impaired health-related quality of life,
fatigue, and reduced mobility [13]. Other common symptoms
include cognitive impairment, depression, and emotional lability
[1,2].
Yoga is rooted in Indian philosophy and has been a part of
traditional Indian spiritual practice for millennia [4]. Yoga
traditionally is a complex intervention that comprises not only
physical activity but also advice for ethical lifestyle, spiritual
practice, breathing exercises, and meditation. While the ultimate
goal of traditional yoga has been described as uniting mind, body,
and spirit, yoga has become a popular means to promote physical
and mental well-being [4,5]. In North America and Europe, yoga
is most often associated with physical postures (asanas), breathing
techniques (pranayama), and meditation (dhyana); and different
yoga forms have emerged that put varying focus on physical and
mental practices [4]. In North America and Europe, yoga is
gaining increased popularity as a therapeutic method. About 14
million adult Americans (more than 6% of the population)
reported that yoga had been recommended to them by a physician
or therapist [6]. Indeed, about half of American yoga practitioners
(more than 13 million people) reported that they had started
practice explicitly to improve their health [7,8].
While systematic reviews and meta-analyses have evaluated the
efficacy and safety of yoga for a number neuropsychiatric disorders
[911], the evidence of efficacy of yoga in multiple sclerosis has not
yet been systematically assessed. Thus, the aim of this review was
to systematically evaluate and meta-analyze the available data on
efficacy and safety of yoga in improving health-related quality of
life, fatigue, mobility, mood, and cognitive function in patients
with multiple sclerosis.
This review was planned and conducted in accordance with the
Preferred Reporting Items for Systematic Reviews and
MetaAnalyses (PRISMA) guidelines [12] (Checklist S1) and
recommendations of the Cochrane Collaboration [13]. The review
protocol was developed a priori and not modified during the
conduct of the review.
Eligibility criteria
Types of studies. Randomized controlled trials (RCTs),
randomized cross-over studies, and cluster-randomized trials were
eligible. No language restrictions were (...truncated)