Original Title: Eficacia y seguridad del yoga en condiciones clínicas seleccionadas

Authors' objectives: This review evaluates the effects of the use of yoga in the following clinical conditions: breast and haematological cancer, recurrent abdominal pain in children, chronic low back pain, respiratory diseases, neurological diseases, schizophrenia and urinary incontinence.

Authors' results and conclusions: RESULTS: An update from 2014 of previous reviews was carried out and 73 systematic reviews were identified. After reading the full text, 20 SRs were finally included that met the previously defined selection criteria and that analysed the efficacy of yoga in the selected clinical conditions. Breast cancer Six included systematic reviews, one of which was of high quality, evaluated the intervention of yoga in the treatment of some symptoms associated with the diagnosis and treatment of breast cancer related to fatigue, mental health and quality of life. They include randomized controlled trials (RCTs) assessing the outcomes of fatigue, depression, anxiety and sleep disturbances. The high quality SR includes 24 RCTs that compare intervention with any type of active therapy - such as exercise and psychosocial interventions, or with inactive controls as usual care on waiting list and non-treatment care. There is moderate quality evidence that yoga may be effective in the short term as a supportive intervention in improving quality of life, reducing fatigue and improving sleep disturbances in breast cancer patients compared to no therapy, as well as reducing depression, anxiety and fatigue compared to psychosocial and educational interventions. Haematological Cancer An SR has been identified that assessed the effects of yoga in combination with standard cancer treatment in people with haematological malignancies. Only one RCT of 39 participants comparing Tibetan yoga with standard care in waiting list patients was included. The included RCT was at high risk of bias due to lack of blinding of participants and researchers and loss to follow-up. This study found no significant differences between the yoga group and the control group in measures of stress, fatigue, anxiety or depression. However, it found differences favourable to the yoga group in quality of sleep. With the available evidence, no reliable conclusions can be drawn regarding the efficacy of yoga as a treatment for haematological malignancies. Recurrent abdominal pain in children A medium quality SR included 3 RCTs at high risk of bias assessing the effect of yoga interventions. The limited number of studies and their low quality do not allow conclusions to be drawn about the efficacy of yoga in recurrent abdominal pain in children. Chronic low-back pain Two SR, one high quality and one very low quality, have assessed the effects of yoga on chronic non-specific low back pain. Twelve RCTs with a high risk of bias were included in the high-quality SR. There is no evidence that there are differences in improvement of function or back pain compared to active exercise-based controls. The differences observed in function and pain compared to inactive controls are moderate and of little clinical relevance. Neuromuscular Impairment A critically low quality SR that included 14 studies on the effect of yoga on balance in patients with neuromuscular conditions or impairment, of which 6 are RCTs, all at high risk of bias. The low quality of the included studies does not allow any conclusion about the effect of yoga in this clinical situation. Epilepsy A high quality SR includes 2 RCTs of low size and high risk of bias. Due to the small number and low quality of available studies, no conclusions can be made about the efficacy of yoga in the treatment of uncontrolled epilepsy. Multiple sclerosis A low quality SR includes 3 studies on the effects of yoga, of which one is an RCT. No significant effects of yoga were found in any of the quality of life domains assessed. Stroke A high quality SR on the effect of yoga in the rehabilitation of stroke patients includes two RCTs with a high risk of bias. The comparator is the usual control and follow-up or no treatment. No significant differences in quality of life outcomes were observed, balance, mobility and motor function assessed. The available evidence does not allow concluding about the effectiveness of yoga in the rehabilitation of patients who have suffered a stroke. Asthma A high quality SR reviews the effects of yoga on patients with asthma. It includes 15 RCTs, of which only one has a low risk of bias. The differences observed in quality of life and improvement of asthma symptoms favour yoga, but are very limited and of uncertain clinical relevance. The low quality of the included studies does not allow conclusions to be drawn about the efficacy of yoga in patients with asthma. Chronic Obstructive Pulmonary Disease Two SR on the effects of yoga in Chronic Obstructive Pulmonary Disease (COPD) patients are of critically low quality, including 4 and 8 RCTs respectively. Comparators are usual care or no intervention. The low quality of the reviews and the limitations of the included studies do not allow any conclusion on the efficacy of yoga in COPD patients. Schizophrenia Two SR, one high quality and one critically low quality, evaluate the effect of yoga in the treatment of patients with schizophrenia. The high quality SR included 9 low to moderate quality RCTs. Comparators used were usual care, physical exercise and psychoeducational interventions. Although some results analysed were favourable to the yoga groups, the low to moderate evidence, the limited size of the studies and the short follow-ups do not allow to conclude on the efficacy of yoga in patients with schizophrenia. Urinary incontinence in women A high quality SR included two RCTs with high risk of bias, one using a mindfulness stress reduction intervention and one without intervention (waiting list) as a comparator. The small number of studies available and their low quality do not allow conclusions to be dawn on the effectiveness of yoga in the treatment of urinary incontinence in women. FINAL CONCLUSION: The available evidence does not allow to drow definitive conclusions on the efficacy and safety of yoga in improving the quality of life and improving the side effects caused by treatment in women with breast cancer, in improving the quality of life of patients with haematological cancer, in improving abdominal pain in children, in improving nonspecific chronic low back pain, in the improvement of epilepsy symptoms, in the improvement of the quality of life of patients with multiple sclerosis, in the rehabilitation of stroke patients, in the prevention of falls in patients with -neuromuscular impairment, in the improvement of asthma or COPD symptoms, in the improvement of schizophrenia symptoms and in the improvement of urinary incontinence in women. Evidence on the safety of yoga interventions suggests that yoga is not associated with serious adverse events, although mild adverse events related to musculoskeletal problems may occur. The limitations in the quality of the systematic reviews (SR) and the limited number of available studies - in many of the clinical conditions evaluated, do not allow offering reliable conclusions on the efficacy and safety of the use of yoga as a therapeutic or rehabilitative intervention in the clinical conditions evaluated.

Project Status: Completed

Year Published: 2021

URL for published report: https://redets.sanidad.gob.es/productos/buscarProductos.do?metodo=detalle&id=1083

Requestor: Spanish Ministry of Health

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Spain

Organisation Name: Agencia de Evaluacion de Tecnologias Sanitarias

Contact Address: Instituto de Salud "Carlos III", Calle Sinesio Delgado 6, Pabellon 4, 28029 Madrid, Spain. Tel: +34 9 1 822 2005; Fax: +34 9 1 387 7841;

Contact Name: Luis M. Sánchez Gómez

Contact Email: luism.sanchez@isciii.es

Copyright: <p>Agencia de Evaluacion</p>