The influence of yoga-based programs on risk profiles in adults with type 2 diabetes mellitus: a systematic review

Kim E Innes, Heather K Vincent, Kim E Innes, Heather K Vincent

Abstract

There is growing evidence that yoga may offer a safe and cost-effective intervention for Type 2 Diabetes mellitus (DM 2). However, systematic reviews are lacking. This article critically reviews the published literature regarding the effects of yoga-based programs on physiologic and anthropometric risk profiles and related clinical outcomes in adults with DM 2. We performed a comprehensive literature search using four computerized English and Indian scientific databases. The search was restricted to original studies (1970-2006) that evaluated the metabolic and clinical effects of yoga in adults with DM 2. Studies targeting clinical populations with cardiovascular disorders that included adults with comorbid DM were also evaluated. Data were extracted regarding study design, setting, target population, intervention, comparison group or condition, outcome assessment, data analysis and presentation, follow-up, and key results, and the quality of each study was evaluated according to specific predetermined criteria. We identified 25 eligible studies, including 15 uncontrolled trials, 6 non-randomized controlled trials and 4 randomized controlled trials (RCTs). Overall, these studies suggest beneficial changes in several risk indices, including glucose tolerance and insulin sensitivity, lipid profiles, anthropometric characteristics, blood pressure, oxidative stress, coagulation profiles, sympathetic activation and pulmonary function, as well as improvement in specific clinical outcomes. Yoga may improve risk profiles in adults with DM 2, and may have promise for the prevention and management of cardiovascular complications in this population. However, the limitations characterizing most studies preclude drawing firm conclusions. Additional high-quality RCTs are needed to confirm and further elucidate the effects of standardized yoga programs in populations with DM 2.

Keywords: blood pressure; cardiovascular disease; coagulation; glycemia; insulin resistance; lipids; lung function; oxidative stress; sympathetic activity.

Figures

Figure 1.
Figure 1.
Hypothesized pathways by which yoga intervention may reduce risk for Type 2 Diabetes mellitus (DM 2) and for complications related to DM 2.

References

    1. Rizvi AA. Type 2 diabetes: epidemiologic trends, evolving pathogenetic [corrected] concepts, and recent changes in therapeutic approach. [see comment] [erratum appears in South Med J 2005;98:4] South Med J. 2004;97:1079–87.
    1. National Center for Chronic Disease Prevention and Health Promotion. National Diabetes Fact Sheet (2002). Centers for Disease Control. Available at: .
    1. Douaihy K. Prediabetes & atherosclerosis: what's the connection? Nurse Pract. 2005;30:24–35.
    1. Posner B, Franz M, Quatromoni P. Nutrition and the global risk for chronic diseases: the INTERHEALTH Nutrition Initiative. Nutr Rev. 1994;52:210–07.
    1. Correa-Rotter R, Naicker S, Katz IJ, Agarwal SK, Herrera Valdes R, Kaseje D, et al. Demographic and epidemiologic transition in the developing world: role of albuminuria in the early diagnosis and prevention of renal and cardiovascular disease. Kidney Int Suppl. 2004;92:S32–7.
    1. Lerman-Garber I, Villa AR, Caballero E. Diabetes and cardiovascular disease. Is there a true Hispanic paradox? Rev Invest Clin. 2004;56:282–96.
    1. American Diabetes Association. American Diabetes Association: clinical practice recommendations. Diabetes Care. 2004;27:S1–9.
    1. Cosentino F, Assenza GE. Diabetes and inflammation. Herz. 2004;29:749–59.
    1. Caglayan E, Blaschke F, Takata Y, Hsueh WA. Metabolic syndrome-interdependence of the cardiovascular and metabolic pathways. Curr Opin Pharmacol. 2005;5:135–42.
    1. Rennert NJ, Charney P. Preventing cardiovascular disease in diabetes and glucose intolerance: evidence and implications for care. Prim Care. 2003;30:569–92.
    1. McVeigh GE, Cohn JN. Endothelial dysfunction and the metabolic syndrome. Curr Diab Rep. 2003;3:87–92.
    1. Grundy S. Hypertriglyceridemia, insulin resistance, and the metabolic syndrome. Am J Cardiol. 1999;83:25F–9F.
    1. Ginsberg H. Insulin resistance and cardiovascular disease. J Clin Invest. 2000;106:453–8.
    1. Isomaa B. A major health hazard: the metabolic syndrome. Life Sci. 2003;73:2395–11.
    1. Watkins LO. Epidemiology and burden of cardiovascular disease. Clin Cardiol. 2004;;27
    1. Reilly M, Rader D. The metabolic syndrome: more than the sum of its parts? Circulation. 2003;108:1546–51.
    1. Reaven G, Abbasi F, McLaughlin T. Obesity, insulin resistance, and cardiovascular disease. Recent Prog Horm Res. 2004;59:207–23.
    1. Maritim A, Sanders R, Watkins Diabetes, oxidative stress, and antioxidants: a review. J Biochem Mol Toxicol. 2003;17:24–38.
    1. Wellen KE, Hotamisligil GS. Inflammation, stress, and diabetes. J Clin Invest. 2005;115:1111–9.
    1. Schiekofer S, Balletshofer B, Andrassy M, Bierhaus A, Nawroth PP. Endothelial dysfunction in diabetes mellitus. Semin Thromb Hemost. 2000;26:503–11.
    1. Stas SN, El-Atat FA, Sowers JR. Pathogenesis of hypertension in diabetes. Rev Endocr Metab Disord. 2004;5:221–5.
    1. Wheatcroft SB, Williams IL, Shah AM, Kearney MT. Pathophysiological implications of insulin resistance on vascular endothelial function. Diabet Med. 2003;20:255–68.
    1. Lawlor DA, Ebrahim S, Smith GD. Associations of measures of lung function with insulin resistance and Type 2 diabetes: findings from the British Women's Heart and Health Study. Diabetologia. 2004;47:195–203.
    1. Davis WA, Knuiman M, Kendall P, Grange V, Davis TM. Glycemic exposure is associated with reduced pulmonary function in type 2 diabetes: the Fremantle Diabetes Study. Diabetes Care. 2004;27:752–7.
    1. Ford ES, Mannino DM. Prospective association between lung function and the incidence of diabetes: findings from the National Health and Nutrition Examination Survey Epidemiologic Follow-up Study. Diabetes Care. 2004;27:2966–70.
    1. Beske SD, Alvarez GE, Ballard TP, Davy KP. Reduced cardiovagal baroreflex gain in visceral obesity: implications for the metabolic syndrome. Am J Physiol Heart Circ Physiol. 2002;282:H630–5.
    1. Bjorntorp P, Holm G, Rosmond R. Hypothalamic arousal, insulin resistance and Type 2 diabetes mellitus. [see comment] Diabet Med. 1999;16:373–83.
    1. Egan BM. Insulin resistance and the sympathetic nervous system. Curr Hypertens Rep. 2003;5:247–54.
    1. Esler M, Rumantir M, Wiesner G, Kaye D, Hastings J, Lambert G. Sympathetic nervous system and insulin resistance: from obesity to diabetes. Am J Hypertens. 2001;14:304S–9S.
    1. Palatini P. Sympathetic overactivity in hypertension: a risk factor for cardiovascular disease. Curr Hypertens Rep. 2001;3(Suppl 1:):S3–9.
    1. Esler M, Rumantir M, Wiesner G, Kaye D, Hastings J, Lambert G. Sympathetic nervous system and insulin resistance: from obesity to diabetes. Am J Hypertens. 2001;14:304S–9S.
    1. Perin PC, Maule S, Quadri R. Sympathetic nervous system, diabetes, and hypertension. Clin Exp Hypertens. 2001;23:45–55.
    1. Bjorntorp P. Body fat distribution, insulin resistance, and metabolic diseases. Nutrition. 1997;13:795–803.
    1. Vitaliano PP, Scanlan JM, Zhang J, Savage MV, Hirsch IB, Siegler IC. A path model of chronic stress, the metabolic syndrome, and coronary heart disease. Psychosom Med. 2002;64:418–35.
    1. Weber B, Schweiger U, Deuschle M, Heuser I. Major depression and impaired glucose tolerance. Exp Clin Endocrinol Diabetes. 2000;108:187–90.
    1. Okamura F, Tashiro A, Utumi A, Imai T, Suchi T, Tamura D, et al. Insulin resistance in patients with depression and its changes during the clinical course of depression: minimal model analysis. Metab Clin Exp. 2000;49:1255–60.
    1. Raikkonen K, Matthews KA, Kuller LH. The relationship between psychological risk attributes and the metabolic syndrome in healthy women: antecedent or consequence? Metab Clin Exp. 2002;51:1573–7.
    1. Chan O, Inouye K, Riddell MC, Vranic M, Matthews SG. Diabetes and the hypothalamo-pituitary-adrenal (HPA) axis. Minerva Endocrinol. 2003;28:87–102.
    1. Nelson TL, Palmer RF, Pedersen NL, Miles TP. Psychological and behavioral predictors of body fat distribution: age and gender effects. Obes Res. 1999;7:199–207.
    1. Rosmond R. Stress induced disturbances of the HPA axis: a pathway to Type 2 diabetes? Med Sci Monit. 2003;9:RA35–9.
    1. Drapeau V, Therrien F, Richard D, Tremblay A. Is visceral obesity a physiological adaptation to stress? Panminerva Med. 2003;45:189–95.
    1. Chen CC, Lu FH, Wu JS, Chang CJ. Correlation between serum lipid concentrations and psychological distress. Psychiatry Res. 2001;102:153–62.
    1. Lucini D, Norbiato G, Clerici M, Pagani M. Hemodynamic and autonomic adjustments to real life stress conditions in humans. Hypertension. 2002;39:184–8.
    1. Levenstein S, Smith M, Kaplan G. Psychosocial predictors of hypertension in men and women. Arch Intern Med. 2001;161:1341–6.
    1. Pickering T, Clemow L, Davidson K, Gerin W. Behavioral cardiology—has its time finally arrived? Mt Sinai J Med. 2003;70:101–12.
    1. Davidson K, Jonas B, Dixon K, Markovitz J. Do depression symptoms predict early hypertension incidence in young adults in the CARDIA study? Coronary Artery Risk Development in Young Adults. [Multicenter Study] Arch Intern Med. 2000;160:1495–500.
    1. Ariyo A, Haan M, Tangen C, Rutledge J, Cushman M, Dobs A, et al. Depressive symptoms and risks of coronary heart disease and mortality in elderly Americans. Cardiovascular Health Study Collaborative Research Group. Circulation. 2000;102:1773–91.
    1. Spieker LE, Hurlimann D, Ruschitzka F, Corti R, Enseleit F, Shaw S, et al. Mental stress induces prolonged endothelial dysfunction via endothelin-A receptors. Circulation. 2002;105:2817–20.
    1. Cannon RO., 3rd Role of nitric oxide in cardiovascular disease: focus on the endothelium. [erratum appears in Clin Chem 1998;44:2070] Clin Chem. 1998;44:1809–19.
    1. Sherwood A, Johnson K, Blumenthal JA, Hinderliter AL. Endothelial function and hemodynamic responses during mental stress. Psychosom Med. 1999;61:365–70.
    1. Eaton W, Armenian H, Gallo J, Pratt L, Ford D. Depression and risk for onset of type II diabetes. A prospective population-based study. [comment] Diabetes Care. 1996;19:1097–102.
    1. Black PH, Garbutt LD. Stress, inflammation and cardiovascular disease. J Psychosom Res. 2002;52:1–23.
    1. von Kanel R, Mills PJ, Fainman C, Dimsdale JE. Effects of psychological stress and psychiatric disorders on blood coagulation and fibrinolysis: a biobehavioral pathway to coronary artery disease? Psychosom Med. 2001;63:531–44.
    1. Goodman E, Whitaker R. A prospective study of the role of depression in the development and persistence of adolescent obesity. Pediatrics. 2002;110:497–504.
    1. Lustman PJ, Clouse RE. Depression in diabetic patients: the relationship between mood and glycemic control. J Diabetes Complicat. 2005;19:113–22.
    1. Musselman D, Betan E, Larsen H, Phillips L. Relationship of depression to diabetes types 1 and 2: epidemiology, biology, and treatment. Biol Psychiatry. 2003;54:317–29.
    1. Rozanski A, Blumenthal JA, Kaplan J. Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy. [comment] Circulation. 1999;99:2192–217.
    1. Bunker SJ, Colquhoun DM, Esler MD, Hickie IB, Hunt D, Jelinek VM, et al. “Stress” and coronary heart disease: psychosocial risk factors. Med J Aust. 2003;178:272–6.
    1. Greenwood DC, Muir KR, Packham CJ, Madeley RJ. Coronary heart disease: a review of the role of psychosocial stress and social support. J Public Health Med. 1996;18:221–31.
    1. Kop WJ. The integration of cardiovascular behavioral medicine and psychoneuroimmunology: new developments based on converging research fields. Brain Behav Immun. 2003;17:233–7.
    1. Todaro JF, Shen BJ, Niaura R, Spiro A, 3rd, Ward KD. Effect of negative emotions on frequency of coronary heart disease (The Normative Aging Study) Am J Cardiol. 2003;92:901–6.
    1. Carney RM, Freedland KE, Miller GE, Jaffe AS. Depression as a risk factor for cardiac mortality and morbidity: a review of potential mechanisms. J Psychosom Res. 2002;53:897–902.
    1. Everson-Rose SA, Meyer PM, Powell LH, Pandey D, Torrens JI, Kravitz HM, et al. Depressive symptoms, insulin resistance, and risk of diabetes in women at midlife. Diabetes Care. 2004;27:2856–62.
    1. Palinkas LA, Lee PP, Barrett-Connor E. A prospective study of Type 2 diabetes and depressive symptoms in the elderly: the Rancho Bernardo Study. Diabet Med. 2004;21:1185–91.
    1. Sahay B. Yoga and diabetes. J Assoc Physicians India. 1986;34:645–8.
    1. Telles S, Naveen K. Yoga for rehabilitation: an overview. Indian J Med Sci. 1997;51:123–7.
    1. Pandya D, Vyas V, Vyas S. Mind-body therapy in the management and prevention of coronary disease. Compr Ther. 1999;25:283–93.
    1. Damodaran A, Malathi A, Patil N, Shah N, Suryavansihi Marathe S. Therapeutic potential of yoga practices in modifying cardiovascular risk profile in middle aged men and women. [comment]. [Clinical Trial] J Assoc Physicians India. 2002;50:633–40.
    1. Sahay B, Sahay R. Lifestyle modification in management of diabetes mellitus. J Indian Med Assoc. 2002;100:178–80.
    1. Garfinkel M, Schumacher HJ. Yoga. Rheum Dis Clin North Am. 2000;26:125–32.
    1. Chandler K. The emerging field of yoga therapy. Hawaii Med J. 2001;60:286–7.
    1. Raub J. Psychophysiologic effects of Hatha Yoga on musculoskeletal and cardiopulmonary function: a literature review. J Altern Complement Med. 2002;8:797–812.
    1. Feuerstein G. The Deeper Dimension of Yoga: Theory and Practice. Boston: Shambhala Publications; 2003.
    1. Innes K, Bourguignon C, Taylor A. Risk indices associated with the insulin resistance syndrome, cardiovascular disease, and possible protection with yoga: a systematic review. J Am Board Fam Pract. 2005;18:491–519.
    1. Labarthe D, Ayala C. Nondrug interventions in hypertension prevention and control. Cardiol Clin. 2002;20:249–63.
    1. Gimbel M. Yoga, meditation, and imagery: clinical applications. Nurse Pract Forum. 1998;9:243–55.
    1. Wood C. Mood change and perceptions of vitality: a comparison of the effects of relaxation, visualization and yoga. J R Soc Med. 1993;86:254–8.
    1. Miller J, Fletcher K, Kabat-Zinn J. Three-year follow-up and clinical implications of a mindfulness meditation-based stress reduction intervention in the treatment of anxiety disorders. Gen Hosp Psychiatry. 1995;17:192–200.
    1. Manchanda S, Narang R, Reddy K, Sachdeva U, Prabhakaran D, Dharmanand S, et al. Retardation of coronary atherosclerosis with yoga lifestyle intervention. [Randomized Controlled Trial] J Assoc Physicians India. 2000;48:687–94.
    1. Patel C, Marmot M, Terry D, Carruthers M, Hunt B, Patel M. Trial of relaxation in reducing coronary risk: four year follow-up. Br Med J. 1985;290:1103–6.
    1. Jayasinghe SR. Yoga in cardiac health (a review) Eur J Cardiovasc Prev Rehabil. 2004;11:369–75.
    1. Innes KE, Bourguignon C, Taylor AG. Risk indices associated with the insulin resistance syndrome, cardiovascular disease, and possible protection with yoga: a systematic review. J Am Board Fam Pract. 2005;18:491–519.
    1. Singh S, Malhotra V, Singh KP, Madhu SV, Tandon OP. Role of yoga in modifying certain cardiovascular functions in type 2 diabetic patients. J Assoc Physicians India. 2004;52:203–6.
    1. Kerr D, Gillam E, Ryder J, Trowbridge S, Cavan D, Thomas P. An Eastern art form for a Western disease: randomised controlled trial of yoga in patients with poorly controlled insulin-treated diabetes. Pract Diabetes Intern. 2002;19:164–6.
    1. Elder C. Ayurveda for diabetes mellitus: a review of the biomedical literature. Altern Ther Health Med. 2004;10:44–50.
    1. Wang C, Collet JP, Lau J. The effect of Tai Chi on health outcomes in patients with chronic conditions: a systematic review. Arch Intern Med. 2004;164:493–501.
    1. Verhagen AP, Immink M, van der Meulen A, Bierma-Zeinstra SM. The efficacy of Tai Chi Chuan in older adults: a systematic review. Fam Pract. 2004;21:107–13.
    1. Bijlani RL, Vempati RP, Yadav RK, Ray RB, Gupta V, Sharma R, et al. A brief but comprehensive lifestyle education program based on yoga reduces risk factors for cardiovascular disease and diabetes mellitus. J Altern Complement Med. 2005;11:267–74.
    1. Yogendra J, Yogendra H, Ambardekar S, Leie R, Shetty S, Dave M, et al. Beneficial effects of yoga lifestyle on reversibility of ischaemic heart disease: Caring Heart Project of International Board of Yoga. JAPI. 2004;52:283–9.
    1. Fields JZ, Walton KG, Schneider RH, Nidich S, Pomerantz R, Suchdev P, et al. Effect of a multimodality natural medicine program on carotid atherosclerosis in older subjects: a pilot trial of Maharishi Vedic Medicine. Am J Cardiol. 2002;89:952–8.
    1. Sahay B. Yoga and diabetes. J Assoc Physicians India. 1986;34:645–8.
    1. Divekar M, Bhat M, Mulla A. Effect of yoga therapy in diabetes and obesity. J Diabet Assoc India. 1978;17:75–8.
    1. Shembakar A, Kate S. Yogic exercise in the management of diabetes mellitus. J Diabet Assoc India. 1980;20:167–71.
    1. Gore M. Yogic treatment for diabetes. Yoga Mimamsa. 1988;26:130–45.
    1. Mukherjee A, Bandyopadhyay S, Benerjee S, Maity A. The influence of yogic exercise on blood sugar level in normal and diabetic volunteers. Indian J Physiol Allied Sci. 1989;43:105–12.
    1. Mukherjee A, Banerjee S, Bandyopadhyay S, Mukherjee P. Studies on the interrelationship between insulin tolerance and yoga. Indian J Physiol Allied Sci. 1992;46:110–5.
    1. Singh S, Malhotra V, Singh K, Sharma S. A preliminary report on the role of yoga asanas on oxidative stress in non-insulin dependent diabetes. Indian J Clin Biochem. 2001;16:216–20.
    1. Malhotra V, Singh S, Singh K, Gupta P, Sharma S, Madhu S, et al. Study of yoga asanas in assessment of pulmonary function in NIDDM patients. Indian J Physiol Pharmacol. 2002;46:313–20.
    1. Jain S, Uppal A, Bhatnagar S, Talukdar B. A study of response pattern of non-insulin dependent diabetics to yoga therapy. Diabetes Res Clin Pract. 1993;19:69–74.
    1. Jain S, Talukdar B. Role of yoga in control of hyperglycemia in middle aged patients of non-insulin dependent diabetes mellitus. Indian J Clin Biochem. 1995;10:62–5.
    1. Monro R, Power J, Coumar A, Dandona P. Yoga therapy for NIDDM: a controlled trial. Complement Med Res. 1992;6:66–8.
    1. Khare K, Jain D. Effect of yoga on plasma glucose and serum fructosamine level in NIDDM. Yoga Mimamsa. 1999;33:1–9.
    1. Malhotra V, Singh S, Tandon O, Madhu S, Prasad A, Sharma S. Effect of Yoga asanas on nerve conduction in type 2 diabetes. Indian J Physiol Pharmacol. 2002;46:298–306.
    1. Yogendra J, Yogendra H, Ambardekar S, Leie R, Shetty S, Dave M, et al. Beneficial effects of yoga lifestyle on reversbility of ischaemic heart disease: Caring Heart Project of International Board of Yoga. J Assoc Physicians India. 2004;52:283–9.
    1. Ornish D, Scherwitz LW, Billings JH, Brown SE, Gould KL, Merritt TA, et al. Intensive lifestyle changes for reversal of coronary heart disease. [see comment] [erratum appears in JAMA 1999;281:1380] JAMA. 1998;280:2001–7.
    1. Koertge J, Weidner G, Elliott-Eller M, Scherwitz L, Merritt-Worden TA, Marlin R, et al. Improvement in medical risk factors and quality of life in women and men with coronary artery disease in the Multicenter Lifestyle Demonstration Project. Am J Cardiol. 2003;91:1316–22.
    1. Khare K, Rai S. Study of lipid profile in post myocardial infarction subjects following yogic lifestyle intervention. Indian Pract. 2002;55:369–73.
    1. Sahay BK, Sadasivudu B, Yogi R, Bhaskaracharyulu C, Raju PS, Madhavi S, et al. Biochemical parameters in normal volunteers before and after yogic practices. Indian J Med Res. 1982;76(Suppl:):144–8.
    1. Bhaskaracharyulu C, Sitarama Raju P, Girija Kumari D, Sahay B, Annapurna M, Madhavi S, et al. The effect of yoga on lipo protein profile in diabetics. J Diabetes Assoc India. 1986;26:120–4.
    1. Naruka J, Mathur R, Mathur A. Effect of pranayama practices on fasting blood glucose and serum cholesterol. Indian J Med Sci. 1986;40:149–52.
    1. Schmidt T, Wijga A, Von Zur Muhlen A, Brabant G, Wagner T. Changes in cardiovascular risk factors and hormones during a comprehensive residential three month kriya yoga training and vegetarian nutrition. [Clinical Trial] Acta Physiol Scand Suppl. 1997;640:158–62.
    1. Schmidt T, Wijga A, Von Zur Muhlen A, Brabant G, Wagner T. Changes in cardiovascular risk factors and hormones during a comprehensive residential three month kriya yoga training and vegetarian nutrition. Acta Physiol Scand Suppl. 1997;640:158–62.
    1. Ornish D. Avoiding revascularization with lifestyle changes: The Multicenter Lifestyle Demonstration Project. Am J Cardiol. 1998;82:26.
    1. Chohan IS, Nayar HS, Thomas P, Geetha NS. Influence of yoga on blood coagulation. Thromb Haemost. 1984;51:196–7.
    1. Yadav RK, Ray RB, Vempati R, Bijlani RL. Effect of a comprehensive yoga-based lifestyle modification program on lipid peroxidation. Indian J Physiol Pharmacol. 2005;49:358–62.
    1. Sharma H, Sen S, Singh A, Bhardwaj NK, Kochupillai V, Singh N. Sudarshan Kriya practitioners exhibit better antioxidant status and lower blood lactate levels. Biol Psychol. 2003;63:281–91.
    1. Jatuporn S, Sangwatanaroj S, Saengsiri A, Rattanapruks S, Srimahachota S, Uthayachalerm W, et al. Short-term effects of an intensive lifestyle modification program on lipid peroxidation and antioxidant systems in patients with coronary artery disease. Clin Hemorheol Microcirc. 2003;29:429–36.
    1. Bhattacharya S, Pandey U, Verma N. Improvement in oxidative status with yogic breathing in young healthy males. Indian J Physiol Pharmacol. 2002;46:349–54.
    1. Dhalla N, Temsah R, Netticadan T. Role of oxidative stress in cardiovascular diseases. J Hypertens. 2000;18:655–73.
    1. Lee KU. Oxidative stress markers in Korean subjects with insulin resistance syndrome. Diabetes Res Clin Pract. 2001;54(Suppl 2:):S29–33.
    1. Juhan-Vague I, Morange PE, Alessi MC. The insulin resistance syndrome: implications for thrombosis and cardiovascular disease. Pathophysiol Haemost Thromb. 2002;32:269–73.
    1. Ginsberg HN, Huang LS. The insulin resistance syndrome: impact on lipoprotein metabolism and atherothrombosis. J Cardiovasc Risk. 2000;7:325–31.
    1. Kohler HP. Insulin resistance syndrome: interaction with coagulation and fibrinolysis. Swiss Med Wkly. 2002;132:241–52.
    1. McKeever TM, Weston PJ, Hubbard R, Fogarty A. Lung function and glucose metabolism: an analysis of data from the Third National Health and Nutrition Examination Survey. Am J Epidemiol. 2005;161:546–56.
    1. Tran MD, Holly RG, Lashbrook J, Amsterdam EA. Effects of hatha yoga practice on the health-related aspects of physical fitness. Prev Cardiol. 2001;4:165–70.
    1. Telles S, Nagarathna R, Nagendra HR, Desiraju T. Physiological changes in sports teachers following 3 months of training in Yoga. Indian J Med Sci. 1993;47:235–8.
    1. Joshi L, Joshi V, Gokhale L. Effect of short term ‘Pranayam’ practice on breathing rate and ventilatory functions of lung. Indian J Physiol Pharmacol. 1992;36:105–8.
    1. Harinath K, Malhotra AS, Pal K, Prasad R, Kumar R, Kain TC, et al. Effects of Hatha yoga and Omkar meditation on cardiorespiratory performance, psychologic profile, and melatonin secretion. J Altern Complement Med. 2004;10:261–8.
    1. Birkel DA, Edgren L. Hatha yoga: improved vital capacity of college students. Altern Ther Health Med. 2000;6:55–63.
    1. Berger B, Owen D. Mood alteration with yoga and swimming: aerobic exercise may not be necessary. Percept Mot Skills. 1992;75(3 Pt 2):1331–43.
    1. Malathi A, Damodaran A, Shah N, Patil N, Maratha S. Effect of yogic practices on subjective well being. [Clinical Trial] Indian J Physiol Pharmacol. 2000;44:202–6.
    1. Ray U, Mukhopadhyaya S, Purkayastha S, Asnani V, Tomer O, Prashad R, et al. Effect of yogic exercises on physical and mental health of young fellowship course trainees. [Randomized Controlled Trial] Indian J Physiol Pharmacol. 2001;45:37–53.
    1. Schell F, Allolio B, Schonecke O. Physiological and psychological effects of Hatha-Yoga exercise in healthy women. [Clinical Trial. Controlled Clinical Trial. Journal Article] Int J Psychosom. 1994;41:46–52.
    1. Sahajpal P, Ralte R. Impact of induced yogic relaxation training (IYRT) on stress-level, self-concept and quality of sleep among minority group individuals. J Indian Psychol. 2000;18:66–73.
    1. Lavey R, Sherman T, Mueser KT, Osborne DD, Currier M, Wolfe R. The effects of yoga on mood in psychiatric inpatients. Psychiatr Rehabil J. 2005;28:399–402.
    1. Janakiramaiah N, Gangadhar B, Naga Venkatesha Murthy P, Harish M, Subbakrishna D, Vedamurthachar A. Antidepressant efficacy of Sudarshan Kriya Yoga (SKY) in melancholia: a randomized comparison with electroconvulsive therapy (ECT) and imipramine. J Affect Disord. 2000;57:255–9.
    1. Nespor K. Twelve years of experience with yoga in psychiatry. Int J Psychosom. 1993;40:105–7.
    1. Shannahoff-Khalsa DS, Ray LE, Levine S, Gallen CC, Schwartz BJ, Sidorowich JJ. Randomized controlled trial of yogic meditation techniques for patients with obsessive compulsive disorders. CNS Spectr Intern J Neuropsychiatric Med. 1999;4:34–46.
    1. Cohen L, Warneke C, Fouladi RT, Rodriguez MA, Chaoul-Reich A. Psychological adjustment and sleep quality in a randomized trial of the effects of a Tibetan yoga intervention in patients with lymphoma. Cancer. 2004;100:2253–60.
    1. Mishra M, Sinha RK. Effect of yogic practices on depression and anxiety. J Project Psychol Mental Health. 2001;8:23–7.
    1. Woolery A MH, Sternlieb B, Zeltzer L. A yoga intervention for young adults with elevated symptoms of depression. Altern Ther Health Med. 2004;10:60–3.
    1. Jorm A, Christensen H, Griffiths K, Rodgers B. Effectiveness of complementary and self-help treatments for depression. Med J Aust. 2002;176(Suppl:):S84–96.
    1. Latha, Kaliappan K. Yoga, pranayama, thermal biofeedback techniques in the management of stress and high blood pressure. J Indian Psychol. 1991;9:36–46.
    1. Walia IJ, Mehra P, Grover P, Earnest C, Verma SK. Sanjeev Health status of nurses and yoga. IV. Experiment and results. Nurs J India. 1992;83:27–8.
    1. Ernst E, Rand J, Stevinson C. Complementary therapies for depression: an overview. Arch Gen Psychiatry. 1998;55:1026–32.
    1. Innes K, Vincent H, Taylor A. Chronic stress and insulin-resistance-related indices of cardiovascular disease risk: Part II. A potential role for mind-body therapies. Altern Ther Health Med. 2006 in press.
    1. Innes K, Vincent H, Taylor A. Chronic stress and insulin-resistance-related indices of cardiovascular disease risk: Part I. Neurophysiologic responses and pathologic sequellae. Altern Ther Health Med. 2006 in press.
    1. Poirier P, Giles TD, Bray GA, Hong Y, Stern JS, Pi-Sunyer FX, et al. Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss: an update of the 1997 American Heart Association Scientific Statement on Obesity and Heart Disease from the Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism. Circulation. 2006;113:898–918.
    1. Norris SL, Zhang X, Avenell A, Gregg E, Schmid CH, Lau J. Long-term non-pharmacological weight loss interventions for adults with prediabetes. Cochrane Database Syst Rev. 2005;;2 CD005270.
    1. Vickers A, Goyal N, Harland R, Rees R. Do certain countries produce only positive results? A systematic review of controlled trials. Control Clin Trials. 1998;19:159–66.

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