Yoga, a form of physical activity, is rapidly gaining in popularity and has many health benefits.
Yet healthcare providers have been slow to recognize yoga for its ability to improve health
conditions, and few interventions have been developed that take full advantage of its benefits.
The purpose of this article is to review published studies using yoga programs and to determine
the effect of yoga interventions on common risk factors of chronic diseases (overweight,
hypertension, high glucose level and high cholesterol). A systematic search yielded 32 articles
published between 1980 and April 2007. The studies found that yoga interventions are generally
effective in reducing body weight, blood pressure, glucose level and high cholesterol, but only a
few studies examined long-term adherence. Additionally, not enough studies included diverse
populations at high risk for diabetes and its related common health problems.
Keywords: yoga – chronic disease – risk factors – overweight – hypertension – glucose – cholesterol
Chronic diseases such as heart disease, stroke and
diabetes are leading causes of death in the US (1).
Common conditions for these chronic diseases are
overweight, high blood pressure (BP), high glucose and
high cholesterol. These conditions are commonly associated
with each other. According to a prospective cohort
study focusing on men (2), there were positive relationships
between body mass index (BMI) and hypertension
incidence. Men with a higher BMI have a higher likelihood
to have diabetes and high cholesterol. Another
study with men and women showed that overweight is
linked to type 2 diabetes (3). Even among patients newly
diagnosed with type 2 diabetes, the Hypertension in
Diabetes Study found that 40% had hypertension, and
that hypertension considerably increased mortality in
people with type 2 diabetes (4). Another recent study
found a 79% rate of hypertension in patients who had
received outpatient care for type 2 diabetes for at least
2 years (5). Individuals with impaired glucose tolerance
also are more likely to have risk factors for
cardiovascular disease such as elevated levels of triglycerides
and low-density lipoprotein (LDL) and low levels of
high-density lipoprotein (HDL) (6).
Promising in this regard is appropriate physical activity
because it can reduce body weight, BP, glucose level and
cholesterol (7,8). Yoga, a form of physical activity
consisting of various postures (Asana) and breathing
and meditation techniques (Pranayama) (9), has been
shown to have therapeutic benefits for individuals with a
wide range of health conditions, including hypertension
(10) and diabetes (11). Yoga also appears to be effective
in reducing stress (12) and improving exercise tolerance
as it is related to cardiovascular response (13).
The number of people practicing yoga in the US
increased significantly between 1997 and 2002 (14).
According to the 2002 National Health Interview Survey
(14), 5% of American adults practiced yoga in the month
previous to the study. Yoga also is well received as a
therapeutic intervention; for example, participants in a
yoga intervention for insomnia found that it was easily
learned and performed (15). Despite its popularity and
positive physiologic effects, however, yoga has not been
widely recognized in efforts to prevent and treat major
chronic health conditions. The purpose of this article is to
For reprints and all correspondence: Kyeongra Yang, School of
Nursing, University of Pittsburgh, 415 Victoria Building, 3500 Victoria
Street, Pittsburgh, PA 15261, USA. Tel: +412-624-6943; Fax: +412-
383-7293; E-mail: yangk@pitt.edu
2007 The Author(s)
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/
licenses/by-nc/2.0/uk/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is
properly cited.
review published studies using yoga practice to determine
the effects of yoga on common health problems, such as
overweight, hypertension, high glucose level and high
cholesterol.
Methods
Articles were retrieved from electronic databases
(CINAHL, Ovid MEDLINE and PsychInfo) using yoga
as a keyword. This initial retrieval, performed in April
2007, yielded 2349 articles, of which 861 have been
published since 1980. A search within those 861 articles,
using the keywords overweight, blood pressure, glucose and
cholesterol, identified 56 research articles. After the author
had read the full text of the 56 articles and identified those
that met the purpose of the study, 24 articles were excluded,
mainly because they described outcome variables and
characteristics of yoga that were irrelevant. Poor quality
was not a reason for exclusion, but studies were excluded if
they focused only on meditation or relaxation (Pranayama)
or if they were case studies. This process resulted in a final
total of 32 articles to be reviewed.
The review comprised studies involving yoga interventions
and using an experimental or quasi-experimental
design. In addition, observational studies were included
because they often supply important information beyond
the results of clinical trials (16). Studies that used yoga as a
control, not as an intervention, were included as long as
they provided evidence of the effectiveness of yoga on
variables of interest (overweight, BP, glucose and
cholesterol).
Findings
Of the 32 articles reviewed, 12 described experimental
studies, 18 described quasi-experimental studies and two
described observational studies. Only 2 of the 12 true
experimental studies (17,18) described the randomization
method. Even though risk factors for chronic health
conditions were used as keywords in the search strategy,
many of the studies used healthy adult samples; only half of
the 32 studies actually focused on subjects with diabetes
(19–23), hypertension (10,11,18,24–27), or cardiovascular
disease (28–31). Seven of the studies were conducted in the
US; the others, in India and other countries.
Content of Yoga Programs
Other than duration and frequency, most articles did not
describe the yoga sessions in detail. Only a few articles
(17,20,22,31,32) provided details of the yoga sequences
used. Some listed the names of postures and breathing
techniques. Of the few articles that identified the type
of yoga studied, the most common was Hatha yoga, a
popular form of yoga in the Western world.
The Compendium of Physical Activities, (33) a coding
scheme that classifies physical activity based on energy
expenditure, does not define energy expenditure while
performing various types of yoga. However, Hatha yoga
is classified as a conditioning exercise, in the same
category as stretching, which has a metabolic equivalent
(MET) of 2.5 (1 MET equals the amount of energy used
for resting). A recent study (34) found that when young
adult women (19 to 40-years old) performed a 30-min
session of Hatha yoga, the MET was 2.17. However, if
the session was made more active using Sun Salutations,
a flowing series of physical postures, the MET increased
to 3.74 (SD=0.70).
Frequency and Duration of Yoga Sessions
The total dose of yoga training, which depends on both the
duration and frequency of yoga sessions, also needs to
be considered in evaluating and comparing yoga studies.
The most common duration and frequency of yoga sessions
in the studies were 30–60 min per session and sessions
meeting daily for 4–10 weeks, but many studies used
sessions meeting 2–3 times per week for 8–12 weeks. Some
yoga programs met more frequently than others but for a
shorter time span. For example, in a study by Damodaran
et al. (24), persons with essential hypertension received 1 h
of yoga training daily for 3 months, which is counted as
84 h of training, whereas Ray et al. (32) studied healthy
young adults who received 1 h of yoga training three times a
week for 10 months, for a total of 120 h.
Some findings can be useful in trying to determine
effective durations of yoga sessions. For example, in one
study, 1 h daily yoga practice was associated with significant
reductions in body weight and cholesterol levels
after 4 weeks, and those significant effects lasted for
14 weeks (28). In a study of 20 patients with essential
hypertension, daily 30-min sessions of yoga led to a
decrease in BP by the fifth day (27).
Adherence to the Yoga Program
Any persistent benefits from yoga would rely on long-term
adherence, which was examined in only a few of the
reviewed studies. In some studies, after yoga training,
subjects were asked to continue their programs with daily
home practice (28,35). One of these (35) compared
adherence to yoga practice after a 10-week yoga intervention
between white and black American adults (mean age:
69 years for whites and 70 years for blacks). Although the
dropout rate did not differ significantly (16% for whites,
22% for blacks), the black participants did not engage in
yoga at home as frequently as whites. A different study (36)
found greater compliance with subsequent home practice
among participants in a yoga class that met three times
per week than in those who attended a weekly yoga
class (86% versus 65%, P<0.05). However, found no
488 Yoga
difference in compliance with home practice between
groups engaged in yoga or aerobic exercise (36).
Weight Decreased
According to a retrospective observational study of 15,550
adults aged 53–57 years (37), regular yoga practice for 4 or
more years was significantly associated with weight loss by
overweight participants. Several intervention studies
(10,26,29,31,38–41) also showed that yoga practice was
effective in reducing body weight. After 4-day residential
yoga practice followed by 14 weeks of 1 h daily home
practice, one study (28) found a significant loss in mean
body weight from 72.26 to 70.48 kg among subjects with risk
factors for coronary artery disease (CAD). Other studies
found that yoga was associated with significant weight loss
by subjects with CAD (29–31) and subjects without CAD
(30). Manchanda et al. (29) showed a 7% loss of body
weight among adult men with CAD after 1 year of yoga
practice, and in a study by Schmidt and colleagues, healthy
adults lost an average of 5.7 kg after 3 months of yoga
practice (39). All overweight adults studied by Yogendra
et al. reached a normal weight within 1 year after initiating
yoga-based lifestyle modifications (31). However, this
article did not show the effect size of this change.
Blood Glucose Level Lowered
Of the six studies that examined blood glucose, all found
that yoga was effective in reducing blood glucose level
(11,19–22,31). For example, after 4 months of yoga
practice, fasting glucose fell significantly (from 144 to
119 mg dl1, P<0.005) in a group of adults with type 2
diabetes, (19). Another sample of 24 adults with type 2
diabetes had significantly decreased fasting glucose (from
190.1 to 141.5 mg dl1, P<0.001) after 40 consecutive
days of yoga practice, (20). Adults with normal blood
glucose levels (11) also had significantly lower glucose
levels after 3–4 h of yoga practice for 8 days (P<0.001).
BP Decreased
This review found ample evidence that yoga was effective in
reducing BP. In a group of low-income elderly people,
effects on systolic BP did not differ between a yoga class
and an aerobic exercise class, both held three times a week
for 10 weeks (36). However, eight other studies found that
yoga practice was effective in lowering BP in healthy
samples, regardless of the type of yoga (13,32,38–44). Yoga
practice also significantly improved BP among people
with hypertension (10,11,18,24–27), cardiovascular disease
(28–31) or type 2 diabetes (19–23). For example, in 13
patients, aged 41–60 years, with essential hypertension (25),
BP dropped significantly during the third week of a 4-week
yoga program (1 h per day, 6 days per week), and it
fell further after the program. For example, systolic BP
dropped from 141.7 to 127.9mmHg by the third week and
to 120.7mmHg by the fourth week.
Cholesterol Level Improved
The practice of yoga was associated with significant
decreases in cholesterol among subjects with cardiovascular
disease (28,29), hypertension (11) or type 2 diabetes
(19). One study (28) examined a regimen involving 4 days
of a yoga program at a residential course, followed by 1
year of yoga practice at home. In both men with angina and
asymptomatic participants with CAD risk factors, all lipid
variables except HDL decreased beginning the fourth week
of yoga practice (e.g. total cholesterol fell from 206.6 to
193.6 mgdl1), and the level of total cholesterol continued
falling to 176.06 mg dl1 at 14 weeks. A study of subjects at
risk for cardiovascular disease and diabetes (11) found
significant improvements (P<0.01) in total cholesterol,
triglycerides, LDL, HDL and very-LDL (VLDL, defined
as total cholesterol minus LDL minus HDL) after shortterm
intensive yoga practice (3–4 h per day for 8 days).
Notably, for subjects whose baseline total cholesterol was
200 mg dl1 or higher, the reduction in triglycerides
(from 151.548.9 to 132.750.5mg dl1, P<0.001)
and VLDL (from 36.713.8 to 30.214.6mg dl1,
P<0.001) was significantly greater than in subjects with
lower baseline total cholesterol (triglycerides falling from
113.646.5 to 110.538.1mg dl1, P>0.05; VLDL from
23.712.8 to 23.212.5mg dl1, P>0.05). Finally, a
study of healthy adults over 40 years old found that 5 years
of yoga practice reduced age-related deterioration in
cardiovascular functions (45). Although the article describing
this observational study did not detail the type of yoga
performed nor the frequency or intensity of the yoga
sessions, the data showed a long-term change indicating the
effectiveness of yoga on cardiovascular functioning.
Four studies used aerobic training as an intervention and
yoga as a control (38,43,46,47). One of these, a study of
healthy active people aged 65 years or older (38), found
that aerobic exercise produced no significant reduction in
weight or BP, whereas 4 weeks of yoga practice did lead to
some reduction in weight or BP (for example, systolic BP
decreased from 146 to 139 mmHg). DiPietro et al. (47)
found no change in glucose and insulin responses in their
yoga control group. However, the yoga control group was
monitored to ensure that pulse rates did not exceed 90 beats
per min during yoga practice (47). Therefore, this restriction
should be considered in interpreting this result.
Discussion
The reviews showed that yoga had beneficial effects on
body weight, BP, blood glucose level and cholesterol level
(Fig. 1). Nonetheless, several shortcomings in research on
eCAM 2007;4(4) 489
this topic need to be addressed, in order for clinical
programs to capitalize on these health benefits.
Of the articles describing interventions, only a few
provided details regarding the yoga programs or the
names and sequence of yoga postures. Asana and
Pranayama provide different types of health benefits, and
therapeutic yoga programs can involve various combinations
of these two components. An optimal comparison of
study results thus requires knowing the combination of
Asana and Pranayama used. The sequence of yoga postures
can be inferred from the list of posture names, but more
straightforward information is essential to future studies
seeking to replicate or generalize the results. A related issue
that remains to be resolved is how to standardize yoga
exercises for research purposes.
The optimal duration and intensity required to maximize
the effectiveness of yoga need to be determined, as does the
need for a booster to provide long-term effects. Because the
MET of yoga is low, increasing the frequency may increase
the benefits. However, these factors cannot be judged
from the reviews studies; many articles did not clearly
identify the dosage of the yoga program studied, and they
focused on the short-term health benefits of yoga. Only a
few studies included follow-up data beyond 6 months.
It also remains to be determined whether more intensive
training, that is, a greater dosage, improves the likelihood
of adopting and maintaining active behavior in the
long run.
The samples in the reviewed studies pose additional
dilemmas. It was not a surprise that a large portion of the
studies were conducted in India, where the philosophy and
practice of yoga originated. However, this focus on one
geographical region, where yoga is particularly ingrained
in the culture, limits the generalizability of results. Few
studies have addressed variables of interest specific to
minorities in the US (Blacks, Hispanics and Asians), which
are populations believed to be more vulnerable to type 2
diabetes (48,49) and physical inactivity (8).
Yoga has beneficial effects on various health conditions.
A large portion of the reviewed studies analyzed the
effects of yoga with healthy samples. There is evidence that
yoga practice was more effective in lowering triglycerides
among people with higher cholesterol than those with a
lower cholesterol level (11). Therefore, it is important to
consider participants’ health conditions because there are
possible differences in the effects of yoga by their health
severity.
Conclusions
Analyses of yoga intervention should be designed and
conducted to identify programs best suited for diverse
populations and for specific populations with high-risk
factors for chronic health conditions. Such studies could
guide the development of more practical and effective
interventions.
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YOGA Glucose level ↓
PRACTICE
Physiological changes
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evidences for physiological changes.
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Received February 23, 2007; accepted September 5, 2007