Can yoga show better vascular outcomes than regular exercise among office workers: a scoping review

Neha Susan Jibi Pattamukkil; Poovitha P Shruthi; Rajagopal Kadavigere; Vaishali K; Shivashankar K N; Suresh Sukumar; Sneha Ravichandran; Koustubh Kamath

doi:10.12688/f1000research.135296.1

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Systematic Review

Can yoga show better vascular outcomes than regular exercise among office workers: a scoping review

[version 1; peer review: 2 not approved]

Neha Susan Jibi Pattamukkil¹, Poovitha P Shruthi², Rajagopal Kadavigere³, [...] Vaishali K⁴, Shivashankar K N⁵, Suresh Sukumar ¹, Sneha Ravichandran¹, Koustubh Kamath¹

Neha Susan Jibi Pattamukkil¹, Poovitha P Shruthi², [...] Rajagopal Kadavigere³, Vaishali K⁴, Shivashankar K N⁵, Suresh Sukumar ¹, Sneha Ravichandran¹, Koustubh Kamath¹

PUBLISHED 02 Aug 2023

Author details Author details

¹ Dept of Medical Imaging Technology , Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
² Department of Yoga, Center for Integrative Medicine and Research,, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
³ Department of Radiodiagnosis and Imaging, Kasturba Medical College,, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
⁴ Department of Physiotherapy , Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
⁵ Department of Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India

Neha Susan Jibi Pattamukkil
Roles: Conceptualization, Data Curation

Poovitha P Shruthi
Roles: Investigation, Validation

Rajagopal Kadavigere
Roles: Supervision

Vaishali K
Roles: Supervision

Shivashankar K N
Roles: Writing – Review & Editing

Suresh Sukumar
Roles: Methodology, Supervision

Sneha Ravichandran
Roles: Validation, Writing – Review & Editing

Koustubh Kamath
Roles: Formal Analysis, Writing – Original Draft Preparation

OPEN PEER REVIEW

REVIEWER STATUS

This article is included in the Manipal Academy of Higher Education gateway.

Abstract

Background: Isolated systolic hypertension (ISH) in the elderly is mostly brought on by arterial stiffness with ageing, which results in a lack of vascular compliance. The main cardiovascular (CV) hazards for elderly persons are arterial ageing and high blood pressure (BP). The aim of this study was to investigate if endothelial function in young, middle-aged, and older, healthy persons would be improved by Bikram yoga, a heated form of hatha yoga. Methods: Randomised control trials on yoga, vascular function, exercise, and office employees were used in the study, which was done in four databases (Scopus, PubMed, Ovid, and Science Direct).
Results: 3 of 103 articles were included. We identified improvement of vascular function, FMD and arterial stiffness using yoga intervention. While exercise does not significantly affect ventricular function, yoga significantly reduces heart rate (p = 0.031) and increases pulse pressure (PD). Yoga also results in a mean increase in left ventricular ejection time (LVET), which was observed in the yoga group. The improvement in myocardial function was more pronounced in the yoga group than in the exercise group, according to the between-group analysis, which revealed a significant difference in post-intervention rate-pressure product (RPP) between the yoga and exercise groups. With a P value of 0.004, the mean% Mean Arterial Pressure (MAP) was significantly lower, demonstrating that yoga was effective in lowering MAP. However, older adults, but not younger ones, experienced a significant increase in brachial artery FMD (Flow Mediated Dilation) following the intervention.
Conclusions: Yoga interventions may improve vascular function, arterial stiffness, flow-mediated dilation, heart rate, RRP and MAP, with older adults experiencing a significant increase in brachial artery FMD, suggesting the effectiveness of yoga in improving myocardial function and lowering MAP, particularly in older adults.

Keywords

Yoga, Bikaram yoha, hatha yoga Physical Activity, Vascular Function, FMD, Exercise, Sedentary lifestyle

Corresponding authors: Suresh Sukumar, Koustubh Kamath

Competing interests: No competing interests were disclosed.

Grant information: The author(s) declared that no grants were involved in supporting this work.

Copyright: © 2023 Pattamukkil NSJ et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Pattamukkil NSJ, Shruthi PP, Kadavigere R et al. Can yoga show better vascular outcomes than regular exercise among office workers: a scoping review [version 1; peer review: 2 not approved]. F1000Research 2023, 12:925 (https://doi.org/10.12688/f1000research.135296.1) First published: 02 Aug 2023, 12:925 (https://doi.org/10.12688/f1000research.135296.1) Latest published: 02 Aug 2023, 12:925 (https://doi.org/10.12688/f1000research.135296.1)

Introduction

Endothelial cells (ECs), vascular smooth muscle cells (VSMCs), the autonomic nervous system, adventitial tissues, including inflammatory cells, and vasa vasorum are only a few of the cell types that regulate vascular function.¹ The gradual and quick development of novel biochemical markers and imaging techniques made a risk stratification for the start of cardiovascular disease or the onset of vascular events an extremely difficult process.² Vascular homeostasis is disrupted by endothelial dysfunction, which raised the risk of cardiovascular disease and along with its related events.³ Due to its low impact and low joint stress characteristics, yoga may be a viable substitute for regular exercise among older persons.⁴

We previously reported that the most popular form of hatha yoga in the United States, non-heated hatha yoga, has not been shown to be beneficial in improving vascular function.⁵^,⁶ Bikram (hot) yoga has shown a reduction in arterial stiffness in young people (ages 20 to 39 years), but not in middle-aged persons.⁷ The observed difference in myocardial function and vascular health between younger and older adults following yoga intervention may be attributed to factors such as the shorter duration⁸^,⁹ of the intervention for the older adults, arterial ageing, and elevated blood pressure emerging as primary cardiovascular risk.⁸^,⁹ As people age, structural and functional changes occur in the heart and blood arteries.¹⁰ As a mind-body lifestyle paradigm, isolated systolic hypertension (ISH) in the elderly is principally brought on by the loss of vascular compliance with ageing brought on by the stiffening of arteries.¹¹^–¹⁴ Several studies have demonstrated the positive effects of yoga programmes for both young as well as elderly persons’ cardiovascular health.¹⁵^–¹⁷

Methods

The Arksey and O’Malley framework¹⁶ is the foundation for this review. The following processes were taken: (1) defining the research issue, (2) locating studies that could address it, (3) choosing the study, (4) charting the data, and (5) reporting and summing the findings.

Identifying the research question

Based on topic results and population, we divided this scoping study into two key research issues. Along with office professionals, young adults made up the target population.

The research topic and the desired result are shown in Table 1.

Table 1. Research question and designated outcome.

Research question	Outcomes
Can Yoga show better vascular functions than exercise among office workers?	Arterial diameter, Velocity, Shear rate, Stress rate
What impact does yoga have on vascular function in desk-based workers?	Arterial diameter, Velocity, Shear rate, Stress rate, FMD
What is the different intervention conducted to improve vascular function	Prolonged sitting, Pranayama intervention, Yoga intervention

Identification of relevant studies

Search strategy

Studies on vascular function, yoga, exercise, and office employees were the subjects of a systematic search that was undertaken in four databases (Scopus, PubMed, Ovid, and Science Direct) with the following Bolen operators in the search strategy [((((Yoga) OR (exercise) OR (Physical Activity))) AND (office worker) OR (Desk based workers)) NOT (children)]. The timeline was between 2000 and 2023. MeSH terms are listed in Table 2.

Table 2. MeSH terms.

Patients	Intervention	Comparison	Outcomes
Young adults	Prolonged Sitting	Sedentary Behaviour	Flow Mediate Dilation
Office workers	Exercise	Physical Activity	Artery diameter, Velocity, Shear rate
Desk based professionals	Yoga	Arterial hypertension	Vascular Function

The investigation began in March 2023 and was finished on May 17, 2023. After the last round of searches was completed in front of a senior librarian, an inclusion analysis was carried out after May 20, 2023. Articles included focused on Yoga intervention effects, physical activity, vascular function, and improved body changes. The article’s language were English-based, and the articles covered the outcomes of exercise and yoga intervention while focusing on blood vessel diameter and velocity. The details are added in Figure 1.

Figure 1. Data extraction flow chart.

Charting of data

The Data chart done independently by authors, NS and KK. First we found the article based on the research question, the bias was rectified by SS using MS excel and Rayyan Software. The final data extracted was verified by SR. We tabulated the following information based on the publications we collected: authors, year, the nation in which the study was done, aims, participants, and activity break. Additionally, information about the control group, the washout time, and the major findings regarding hypertension, SB, and PA were collected.

Results

Only three of the 103 publications that were discovered to address the research topic based on yoga, vascular function, and arterial width and velocity were located based on search results from four index databases, as shown in Figure 1. Two studies were conducted in USA, one study conducted in India. Three studies are specially focused on vascular function and arteries. The tabular data on SB, PA, hypertension, and its based treatments are shown in Table 3.

Table 3. Study classification and its characteristics.

Author Country Year of publishing	Objective of the study	Type of the study	Age-range	Type of PA, of exercise/sports	Duration of the activity	Control group	Key findings
Stacy D. Hunter PhD January 2017(USA)	The purpose of this study was to investigate if Bikram yoga, a heated hatha yoga practise, would enhance endothelium function in young, middle-aged, and older, healthy persons.	RCT	47 people in total, ranging in age from 18 to 70, were enlisted.	Bikram yoga	8 weeks of three Bikram yoga classes per week	17 middle aged (ages 18-39) and 19 older adults (age40-70)	The main finding of the current study is that a brief Bikram yoga intervention improved endothelial function as measured by brachial artery FMD in middle-aged (age18-39) and older persons.(age40-70)
Stacy D. Hunter October 2018(USA)	This study’s objectives were to determine the 1000.ts of a 12-week Bikram yoga intervention based on arterial stiffness in middle-aged adults and to investigate any additional impacts that environmental temperature may have had on this measure.	RCT	A total 54 middle aged adults (age 40-60 y)	Bikram yoga	A 12-week Bikram yoga 1000.Editor was used to reduce arterial stiffness in middle-aged persons, and its impact on this measurement was also examined.	-	Twelve weeks of Bikram yoga was performed in heated and thermoneutral conditions did not alter arterial stiffness in apparently healthy, middle-aged adults.
Satish Gurunathrao Patil Aug 23, 2015 (India)	To ascertain yoga’s impact on artery function in older people with elevated pulse pressure (PP).	RCT	Senior individuals (Age 60y) with PP 60 mmHg (n=60)	Yoga, Pranayama and stretching exercise	10-week practice of yoga.		The suggested yoga programme reduced arterial stiffness and BP in elderly people (age 60 y) with elevated PP more effectively than a brisk stroll did. Yoga can improve endothelial function and lower sympathetic activity.

Yoga and vascular function

Gurunathrao S discovered that yoga significantly increases PD (p = 0.042) while decreasing HR (p = 0.031). While there is no difference between the exercise group and the yoga group in terms of ventricular function, the yoga group experienced a mean increase in Left Ventricular Ejection Time (LVET), and the yoga group experienced a significant decrease in RPP. There was no change in the walking exercise group but there was a significant decrease in mean % Mean Arterial Pressure (MAP) within the yoga group (p = 0.004).¹⁸

Bikrama yoga and FMD

The study on the effect of Bikram yoga on endothelial function in young and middle-aged and older adults, examined how Bikram yoga influenced brachial artery flow-mediated dilation among two distinct age groups: young (age 18-39) and middle aged/older individuals (age 40-70).¹⁹ In the older group exhibited significantly higher baseline values for age and body mass, and they tended to have a higher baseline BMI compared to the young group. Surprisingly, the study observed no significant change in the brachial artery flow-mediated dilation after Bikram yoga in the younger group. However, in the older group, Bikram yoga demonstrated significant changes, indicating its effectiveness for this age category.¹⁹

Heated and thermoneutral yoga in arterial stiffness

According to Hunter SD 1000.Editorial.Emerald.al there are no further significant group effects were found for post-intervention body weight, systolic and diastolic blood pressure, pulse, BMI, and mean blood pressure. In one study, after 12 weeks, brachial-ankle PWV in the hot (p = 0.52), thermoneutral (p = 0.75), and control groups remained stable (p = 0.31).⁹

Discussion

Reviewing the evidence, we found that the yoga interventions improved vascular function, flow-mediated dilation, and arterial stiffness.

Yoga and walking exercise

Heart rate (HR)

Ref. 18 the compared the results between a yoga group and an exercise group, specifically focusing on heart rate (HR) and PD. The following findings were observed:

1. Yoga Group:

Within the yoga group, a significant reduction in HR was observed with a p-value of 0.031. This suggests that practicing yoga led to a measurable decrease in heart rate. Additionally, there was an increase in PD with a p-value of 0.042. This indicates that participants in the yoga group experienced an increase in discomfort during the intervention.

2. Exercise Group:

In contrast to the yoga group, no meaningful change was observed within the exercise group for both heart rate and perceived discomfort. This implies that the exercise regimen employed in the study did not lead to significant alterations in these measures.

3. Between Group Comparison:

A significant mean change between the yoga and exercise groups was observed for both heart rate (p-value of 0.036) and perceived discomfort (p-value of 0.002). This indicates that the changes in heart rate and perceived discomfort differed significantly between the two groups. In other words, the effects of yoga on these measures were distinct from the effects of exercise.

Regarding the interpretation of p-values, a p-value less than 0.05 is commonly used to determine statistical significance. In this study, the reported p-values (0.031, 0.042, 0.036, and 0.002) are all below 0.05. Therefore, the observed changes in heart rate and perceived discomfort are considered statistically significant, suggesting that these changes are unlikely to have occurred by chance.

Rate pressure product

The compared results between a yoga group and an exercise group, specifically focusing on rate-pressure product (RPP) as a measure of myocardial performance. The findings of the study indicate the following:

1. Yoga Group:

Within the yoga group, a significant decrease in RPP was observed. The rate-pressure product reflects the workload on the heart, and a decrease in RPP suggests improved cardiac efficiency. This finding suggests that practicing yoga was associated with a beneficial impact on myocardial performance.

2. Exercise Group:

In contrast to the yoga group, the exercise group did not exhibit significant changes in RPP. This implies that the exercise regimen employed in the study (walking exercise) did not result in notable improvements in myocardial performance, as measured by RPP.

3. Between Group Comparison:

The group analysis revealed a significant difference in post-intervention RPP between the yoga and exercise groups. This suggests that the improvement in myocardial performance, as indicated by the decrease in RPP, was more pronounced in the yoga group compared to the exercise group. Therefore, the study implies that yoga may be a more effective treatment than walking exercise for enhancing cardiac performance.¹⁸

Arterial Stiffness

A substantial decrease in mean% MAP was observed in the yoga group, with a P value of 0.004 indicating that yoga was effective in lowering MAP. In contrast, there was no discernible difference in the mean% MAP between the yoga and walking exercise groups. Yoga shows a positive effect on reducing MAP; walking exercises did not produce any significant changes.¹⁸

Endothelial function

The study looked at how Bikrama Yoga affected young, middle-aged, and older people’ flow-mediated dilation (FMD) of the brachial artery.¹⁹

1. Effect of Time and Age Interaction:

The study found that both the entire cohort and different age groups showed significant effects of time on FMD, indicating that FMD changed over the course of the intervention. Additionally, there was a significant time by age interaction, suggesting that the relationship between time and FMD differed across age groups. These findings highlight the relevance of considering age as a factor when examining the effects of Bikram Yoga on FMD.

2. Age and Baseline Characteristics:

At baseline, older age groups had higher body mass and BMI compared to younger individuals. While body weight and BMI tended to decrease in the older age groups during the intervention, there were no significant changes in BMI, body mass, or body fat percentage in either age group as a result of Bikram Yoga. These baseline characteristics and lack of significant changes in body composition provide important context for interpreting the study’s results.

3. Brachial Artery FMD:

Initially, there were no baseline differences in brachial artery FMD between the young and older groups. However, following the Bikram Yoga intervention, only the older adults experienced a significant increase in brachial artery FMD. This suggests that Bikram Yoga may have a positive impact on FMD specifically in middle-aged and older individuals, while younger individuals did not exhibit significant changes in this measure.

Pulse wave velocity

The study you mentioned investigated the effects of hot yoga, thermoneutral yoga, and a control group on various outcomes, including brachial-ankle pulse wave velocity (PWV), blood pressure, BMI, body weight, and pulse.⁹

1. Main Effects of Group:

The study found no significant main effects of group on post-intervention body weight, systolic and diastolic blood pressure, BMI, pulse, and mean blood pressure. This suggests that there were no significant differences in these outcomes among the hot yoga, thermoneutral yoga, and control groups after the intervention period.

2. Brachial-Ankle PWV:

Additionally, there was no significant change in brachial-ankle PWV observed in the hot yoga, thermoneutral yoga, or control groups after the 12⁹-week intervention period. Pulse wave velocity is a measure of arterial stiffness, and the lack of significant change suggests that neither type of yoga had a significant impact on arterial stiffness compared to the control group.

Conclusion

Based on the research studies conducted, it has been consistently demonstrated that yoga has a positive impact on improving vascular function. However, it is important to note that further practice of yoga is necessary to continue experiencing these improvements in vascular function. Looking ahead, it is plausible to anticipate that yoga could serve as an excellent exercise option for office workers, potentially offering a range of benefits for their vascular health.

Limitation

The field of yoga research faces several challenges that affect the ability to draw definitive conclusions. Firstly, there is a notable variation in the types of yoga interventions studied, including Bikram Yoga and unspecified practices. This lack of standardization in the type, duration, frequency, and intensity of interventions hinders the comparison of results and limits our understanding of the effects of yoga on desired outcomes. Secondly, the inclusion of participants from diverse age groups, such as young, middle-aged, and older individuals, introduces heterogeneity that can influence outcomes and complicate result interpretation, especially when considering factors like body mass index (BMI) and body weight. Conducting studies specifically targeting different age groups and accounting for relevant confounding factors would provide more valuable insights. Additionally, each study utilizes different outcome measures, such as heart rate, perceived discomfort, rate-pressure product, flow-mediated dilation (FMD), and pulse wave velocity (PWV), which provide insights into various aspects of cardiovascular health. However, employing standardized and widely accepted measures would enhance comparability and reliability across studies. Lastly, the duration of interventions varies widely, ranging from 12 weeks to unspecified time periods, and longer-term follow-up assessments are needed to comprehensively understand the sustainability and long-term effects of yoga interventions on the desired outcomes.

Future outcomes

Future outcomes in yoga research include the establishment of standardized protocols for different types of yoga interventions, enabling better comparison of study results and definitive conclusions on the effects of yoga. Targeted studies focusing on specific age groups and considering confounding factors would provide more accurate insights. Emphasizing standardized outcome measures would enhance comparability and reliability across studies, facilitating meta-analyses and robust conclusions. Additionally, longer-term follow-up assessments beyond the current intervention durations would shed light on the sustainability and long-term effects of yoga interventions, providing a deeper understanding of their lasting benefits and potential risks. These efforts aim to address existing challenges and improve the quality and reliability of yoga research.

Data availability

All data underlying the results are available as part of the article and no additional source data are required.

References

1. Shimokawa H, Satoh K: Vascular function. Arteriosclerosis, Thrombosis, and Vascular Biology. Vol. 34. . Lippincott Williams and Wilkins; 2014; pp. 2359–2362.
2. Biomarkers as drug development tools: discovery, validation, qualification and use.
3. Chan SY, Mancini GBJ, Kuramoto L, et al.: The prognostic importance of endothelial dysfunction and carotid atheroma burden in patients with coronary artery disease. J. Am. Coll. Cardiol. 2003 Sep 17; 42(6): 1037–1043. Publisher Full Text
4. Oliveros E, Patel H, Kyung S, et al.: Hypertension in older adults: Assessment, management, and challenges. Clinical Cardiology. Vol. 43. . John Wiley and Sons Inc.; 2020; pp. 99–107.
5. Hunter SD, Tarumi T, Dhindsa MS, et al.: Hatha yoga and vascular function: Results fromcross-sectional and interventional studies. J. Bodyw. Mov. Ther. 2013 Jul; 17(3): 322–327. PubMed Abstract | Publisher Full Text
6. Daugherty A, Fisher EA, Taubman MB, et al.: Forty-Year Anniversary of Arteriosclerosis, Thrombosis, and Vascular Biology. Arterioscler. Thromb. Vasc. Biol. 2021; 41(9): 2353–2356. PubMed Abstract | Publisher Full Text | Free Full Text
7. Hunter SD, Dhindsa MS, Cunningham E, et al.: The Effect of Bikram Yoga on Arterial Stiffness in Young and Older Adults. J. Altern. Complement. Med. 2013 Dec; 19(12): 930–934. Publisher Full Text
8. Vlachopoulos C, Aznaouridis K, Stefanadis C: Prediction of Cardiovascular Events and All-Cause Mortality With Arterial Stiffness. A Systematic Review and Meta-Analysis. J. Am. Coll. Cardiol. 2010 Mar 30; 55(13): 1318–1327. Publisher Full Text
9. Hunter SD, Laosiripisan J, Elmenshawy A: Effects of heated and thermoneutral yoga interventions on arterial stiffness in middle-aged adults. Complement. Ther. Med. 2018 Oct 1; 40: 113–115. PubMed Abstract | Publisher Full Text
10. Fleg JL, Strait J: Age-associated changes in cardiovascular structure and function: a fertile milieu for future disease. Heart Fail. Rev. 2012 Sep 2; 17(4–5): 545–554. PubMed Abstract | Publisher Full Text | Free Full Text
11. Lee HY, Oh BH: Aging and arterial stiffness. Circ. J. 2010; 74: 2257–2262. Publisher Full Text
12. Laurent S, Boutouyrie P, Asmar R, et al.: Aortic Stiffness Is an Independent Predictor of All-Cause and Cardiovascular Mortality in Hypertensive Patients.2001. Reference Source
13. Patil SG, Patil SS, Aithala MR, et al.: Comparison of yoga and walking-exercise on cardiac time intervals as a measure of cardiac function in elderly with increased pulse pressure. Indian Heart J. 2017 Jul 1; 69(4): 485–490. PubMed Abstract | Publisher Full Text | Free Full Text
14. Alexander GK, Innes KE, Selfe TK, et al.: “More than I expected”: Perceived benefits of yoga practice among older adults at risk for cardiovascular disease. Complement. Ther. Med. 2013 Feb; 21(1): 14–28. PubMed Abstract | Publisher Full Text | Free Full Text
15. Cramer H, Lauche R, Haller H, et al.: Effects of yoga on cardiovascular disease risk factors: A systematic review and meta-analysis. Int. J. Cardiol. 2014 May 1; 173(2): 170–183. PubMed Abstract | Publisher Full Text
16. Das K, Dhanakshirur G, Patil S, et al.: Comparison of the effects of yoga and lifestyle modification on grade-I hypertension in elderly males: A preliminary study. Int. J. Clin. Exp. Physiol. 2014; 1(1): 68. Publisher Full Text
17. Bharshankar JR, Bharshankar RN, Deshpande VN, et al.: Effect of yoga on cardiovascular system in subjects above 40 years. Indian J. Physiol. Pharmacol. 2003; 47: 202–206. PubMed Abstract
18. Gurunathrao S, If TD, If TD, et al.: Comparison of yoga and walking-exercise on cardiac time intervals as a measure of cardiac function in elderly with increased pulse pressure. Indian Heart J. 2017; 69(4): 485–490. Publisher Full Text
19. Hunter SD, Dhindsa MS, Cunningham E, et al.: ScienceDirect The effect of Bikram yoga on endothelial function in young and middle-aged and older adults. J. Bodyw. Mov. Ther. 2016; 6–10.

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Version 1

VERSION 1 PUBLISHED 02 Aug 2023

Author details Author details

¹ Dept of Medical Imaging Technology , Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
² Department of Yoga, Center for Integrative Medicine and Research,, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
³ Department of Radiodiagnosis and Imaging, Kasturba Medical College,, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
⁴ Department of Physiotherapy , Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
⁵ Department of Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India

Neha Susan Jibi Pattamukkil
Roles: Conceptualization, Data Curation

Poovitha P Shruthi
Roles: Investigation, Validation

Rajagopal Kadavigere
Roles: Supervision

Vaishali K
Roles: Supervision

Shivashankar K N
Roles: Writing – Review & Editing

Suresh Sukumar
Roles: Methodology, Supervision

Sneha Ravichandran
Roles: Validation, Writing – Review & Editing

Koustubh Kamath
Roles: Formal Analysis, Writing – Original Draft Preparation

Competing interests

No competing interests were disclosed.

Grant information

The author(s) declared that no grants were involved in supporting this work.

Article Versions (1)

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Published: 02 Aug 2023, 12:925

https://doi.org/10.12688/f1000research.135296.1

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© 2023 Pattamukkil NSJ et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Pattamukkil NSJ, Shruthi PP, Kadavigere R et al. Can yoga show better vascular outcomes than regular exercise among office workers: a scoping review [version 1; peer review: 2 not approved]. F1000Research 2023, 12:925 (https://doi.org/10.12688/f1000research.135296.1)

NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.

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VERSION 1

PUBLISHED 02 Aug 2023

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Reviewer Report 06 Sep 2023

Nantinee Nualnim, Mahidol University, Salaya, Nakhon Pathom, Thailand

Not Approved

https://doi.org/10.5256/f1000research.148407.r197282

The study aimed to investigate the effect of Bikram yoga on vascular functions using a scope review. It’s interesting as Bikram yoga seems to be a novel form of exercise. However, there are many comments for this article.

... Continue reading

The study aimed to investigate the effect of Bikram yoga on vascular functions using a scope review. It’s interesting as Bikram yoga seems to be a novel form of exercise. However, there are many comments for this article.

Major comments:

1. The topic of this article is not aligned with the study design. The studies that the authors recruit for the review did not mention that the participants are office workers. In addition, there was only one study that compares Bikram yoga with stretching exercise. It’s exaggerated to make a question on the article’s topic that “Can yoga show better vascular outcomes than regular exercise among office workers?”.

2. Introduction:

2.1: There are no rationales to support the objectives of this study mentioned in Table 1. The authors need to provide the information to support the importance of this study. For example, the potential benefits of Bikram yoga over traditional exercise, especially, aerobic exercise that is recommended by many international organizations to be the form of exercise to improve vascular function and essential hypertension. Why did the authors focus on office workers?
2.2: There is no general objective of the study available in the introduction part.

3. Methods:

3.1: It’s unclear about the inclusion and exclusion criteria of the studies that the authors recruited for analyses.
3.2: The 3 studies that were included in the analyses did not go along with the 3 objectives that were mentioned in Table 1. The population did not mention that they are office workers. The study design did not specify that they are a randomized control trial as written in the abstract. Why were some studies in the references excluded from the analysis as it investigated the effect of yoga on vascular functions?
3.3: The number of the studies in the flow chart is a miscalculation. From 103 studies, the authors excluded 27 studies. Why did it leave only 27 studies for further investigation?
3.4: The statistical analyses were not available. If it’s the systematic review, it should summarize the clear results for each research question.

4. Results and discussion:

4.1: There are no data analyses in the results. The authors just reported the findings from each study they recruited. It is not appropriate for a systematic review. They need to recruit relevant numbers of research to answer each of their research questions. They also need to synthesise and analyze data with appropriate statistical analyses.
4.2: The discussion and conclusion of the study is over-reported. In addition, the information they provided is not aligned among the abstract, introduction, methods and results.

Are the rationale for, and objectives of, the Systematic Review clearly stated?

No
Are sufficient details of the methods and analysis provided to allow replication by others?

No
Is the statistical analysis and its interpretation appropriate?

Not applicable
Are the conclusions drawn adequately supported by the results presented in the review?

No

Competing Interests: I am a co-worker with the principal investigators of 2 studies the authors recruited while I was a Ph.D. student. However, I have no affiliation to the included studies within the manuscript.

Reviewer Expertise: Cardiovascular exercise physiology; Cardiovascular risk factors and exercise; Cardiopulmonary physical therapy;

I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above.

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Reviewer Report 23 Aug 2023

James Shadiow, University of Michigan, Ann Arbor, Michigan, USA

Not Approved

https://doi.org/10.5256/f1000research.148407.r197281

This article aims to address the causal effects of novel forms of exercise, Bikram yoga, on metrics of cardiovascular health. It addresses an understudied topic, especially given that adherence to traditional forms of exercise is historically ineffective, leading to epidemics ... Continue reading

This article aims to address the causal effects of novel forms of exercise, Bikram yoga, on metrics of cardiovascular health. It addresses an understudied topic, especially given that adherence to traditional forms of exercise is historically ineffective, leading to epidemics of metabolic and cardiovascular disorders within the United States of America. Despite the relatively small n size of research studies meeting inclusion criteria, readdressing critical flaws in the current manuscript may provide a valuable piece of literature that draws attention to a novel therapeutic supported to preserve or improve metrics of cardiovascular function in subsets of at-risk patient populations.

Are the rationale for and objectives of the Systematic Review clearly stated?

The study's objective is represented in Table 1, comprising three research questions and paired outcomes.
- A singular research question that mends the current three would be appropriate for systematic reviews and improve readability.
There is no rationale for the first two research questions, including samples from office and desk-based workers. This can be sufficed through disseminating information involving sedentary lifestyles in the United States and leveraging the study of these workers to present an appropriate model typical of American workers.
Additionally, these outcomes are not defined, the methodologies of how these outcomes are constructed are not listed, and there is no context to the interpretability of meaningfulness of these outcomes. The authors might define an outcome: "Rate pressure product is calculated by resting heart rate multiplied by systolic blood pressure. This metric indicates cardiac oxygen consumption and allows researchers and clinicians to understand the workload placed on a patient's heart at any given time."

Are sufficient details of the methods and analysis provided to allow replication by others?

No, it is unclear why some studies that utilized a yoga intervention and assessed vascular function metrics included in the current manuscript were excluded. Below are studies that seem to meet the inclusion criteria (PMID):
- Patil et al. (2017¹).
- Patil et al. (2015²).
- Saptharishi et al. (2009³).
There is also a critical flaw in the research questions in Table 1 referencing the investigation of office and desk workers, the included studies in Table 3 do not mention this population.

Is the statistical analysis and its interpretation appropriate?

Statistical analysis: Yes, this systematic review utilized reported statistical analyses and therefore does not need to provide any novel statistics.

Interpretation: No, a systematic review should set a clear outcome and then review the relevant literature to deliver a clear and concise answer to a singular specific question. This study rather individually summarizes three studies that each utilize a vast amount of varying central and peripheral vascular measures and therefore lacks a concise takeaway from these studies meeting the inclusion criteria.

Are the conclusions drawn adequately supported by the results presented in the review?

No, the conclusion is over-reported. There is reported evidence in the included studies that state null findings and lack of significant change in response to Bikram interventions.
Additionally, the outcomes outlined in Table 1 do not align with those mentioned in the Abstract or Results, specifically LVET and RPP. RPP is a metric of cardiac oxygen consumption, while LVET is a metric for cardiac function. Although metrics of any portion of the cardiovascular tree are often related, this paper should either delineate peripheral vascular metrics or central cardiovascular metrics or provide a deduction into the causal improvement of one of these aspects on the other.
The limitations are well-understood and well reported.
The future outcomes are also exceptionally written.

Are the rationale for, and objectives of, the Systematic Review clearly stated?

Partly
Are sufficient details of the methods and analysis provided to allow replication by others?

No
Is the statistical analysis and its interpretation appropriate?

Partly
Are the conclusions drawn adequately supported by the results presented in the review?

Partly

References

1. Patil SG, Patil SS, Aithala MR, Das KK: Comparison of yoga and walking-exercise on cardiac time intervals as a measure of cardiac function in elderly with increased pulse pressure.Indian Heart J. 2017; 69 (4): 485-490 PubMed Abstract | Publisher Full Text
2. Patil SG, Aithala MR, Das KK: Effect of yoga on arterial stiffness in elderly subjects with increased pulse pressure: A randomized controlled study.Complement Ther Med. 2015; 23 (4): 562-9 PubMed Abstract | Publisher Full Text
3. Saptharishi L, Soudarssanane M, Thiruselvakumar D, Navasakthi D, et al.: Community-based Randomized Controlled Trial of Non-pharmacological Interventions in Prevention and Control of Hypertension among Young Adults.Indian J Community Med. 2009; 34 (4): 329-34 PubMed Abstract | Publisher Full Text

Competing Interests: Two of the three studies that met the authors' inclusion criteria are first authored by a previous mentor during my graduate work. However, I have no affiliation to the included studies within the current systematic review manuscript.

Reviewer Expertise: Exercise Physiology, Diabetes, Cardiovascular Disease, Cellular Biology, Endothelial Function, Translational Medicine

I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above.

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James Shadiow, University of Michigan, Ann Arbor, USA
Nantinee Nualnim, Mahidol University, Salaya, Thailand

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Reviewer Report

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06 Sep 2023 | for Version 1

Nantinee Nualnim, Mahidol University, Salaya, Nakhon Pathom, Thailand

11 Views Cite this report Responses(0)

Not Approved

The study aimed to investigate the effect of Bikram yoga on vascular functions using a scope review. It’s interesting as Bikram yoga seems to be a novel form of exercise. However, there are many comments for this article.

Major comments:

1. The topic of this article is not aligned with the study design. The studies that the authors recruit for the review did not mention that the participants are office workers. In addition, there was only one study that compares Bikram yoga with stretching exercise. It’s exaggerated to make a question on the article’s topic that “Can yoga show better vascular outcomes than regular exercise among office workers?”.

2. Introduction:

2.1: There are no rationales to support the objectives of this study mentioned in Table 1. The authors need to provide the information to support the importance of this study. For example, the potential benefits of Bikram yoga over traditional exercise, especially, aerobic exercise that is recommended by many international organizations to be the form of exercise to improve vascular function and essential hypertension. Why did the authors focus on office workers?
2.2: There is no general objective of the study available in the introduction part.

3. Methods:

3.1: It’s unclear about the inclusion and exclusion criteria of the studies that the authors recruited for analyses.
3.2: The 3 studies that were included in the analyses did not go along with the 3 objectives that were mentioned in Table 1. The population did not mention that they are office workers. The study design did not specify that they are a randomized control trial as written in the abstract. Why were some studies in the references excluded from the analysis as it investigated the effect of yoga on vascular functions?
3.3: The number of the studies in the flow chart is a miscalculation. From 103 studies, the authors excluded 27 studies. Why did it leave only 27 studies for further investigation?
3.4: The statistical analyses were not available. If it’s the systematic review, it should summarize the clear results for each research question.

4. Results and discussion:

4.1: There are no data analyses in the results. The authors just reported the findings from each study they recruited. It is not appropriate for a systematic review. They need to recruit relevant numbers of research to answer each of their research questions. They also need to synthesise and analyze data with appropriate statistical analyses.
4.2: The discussion and conclusion of the study is over-reported. In addition, the information they provided is not aligned among the abstract, introduction, methods and results.

Are the rationale for, and objectives of, the Systematic Review clearly stated?

No
Are sufficient details of the methods and analysis provided to allow replication by others?

No
Is the statistical analysis and its interpretation appropriate?

Not applicable
Are the conclusions drawn adequately supported by the results presented in the review?

No

Competing Interests

I am a co-worker with the principal investigators of 2 studies the authors recruited while I was a Ph.D. student. However, I have no affiliation to the included studies within the manuscript.

Reviewer Expertise

Cardiovascular exercise physiology; Cardiovascular risk factors and exercise; Cardiopulmonary physical therapy;

I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above.

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Reviewer Report

16 Views

23 Aug 2023 | for Version 1

James Shadiow, University of Michigan, Ann Arbor, Michigan, USA

16 Views Cite this report Responses(0)

Not Approved

This article aims to address the causal effects of novel forms of exercise, Bikram yoga, on metrics of cardiovascular health. It addresses an understudied topic, especially given that adherence to traditional forms of exercise is historically ineffective, leading to epidemics of metabolic and cardiovascular disorders within the United States of America. Despite the relatively small n size of research studies meeting inclusion criteria, readdressing critical flaws in the current manuscript may provide a valuable piece of literature that draws attention to a novel therapeutic supported to preserve or improve metrics of cardiovascular function in subsets of at-risk patient populations.

Are the rationale for and objectives of the Systematic Review clearly stated?

The study's objective is represented in Table 1, comprising three research questions and paired outcomes.
- A singular research question that mends the current three would be appropriate for systematic reviews and improve readability.
There is no rationale for the first two research questions, including samples from office and desk-based workers. This can be sufficed through disseminating information involving sedentary lifestyles in the United States and leveraging the study of these workers to present an appropriate model typical of American workers.
Additionally, these outcomes are not defined, the methodologies of how these outcomes are constructed are not listed, and there is no context to the interpretability of meaningfulness of these outcomes. The authors might define an outcome: "Rate pressure product is calculated by resting heart rate multiplied by systolic blood pressure. This metric indicates cardiac oxygen consumption and allows researchers and clinicians to understand the workload placed on a patient's heart at any given time."

Are sufficient details of the methods and analysis provided to allow replication by others?

No, it is unclear why some studies that utilized a yoga intervention and assessed vascular function metrics included in the current manuscript were excluded. Below are studies that seem to meet the inclusion criteria (PMID):
- Patil et al. (2017¹).
- Patil et al. (2015²).
- Saptharishi et al. (2009³).
There is also a critical flaw in the research questions in Table 1 referencing the investigation of office and desk workers, the included studies in Table 3 do not mention this population.

Is the statistical analysis and its interpretation appropriate?

Statistical analysis: Yes, this systematic review utilized reported statistical analyses and therefore does not need to provide any novel statistics.

Interpretation: No, a systematic review should set a clear outcome and then review the relevant literature to deliver a clear and concise answer to a singular specific question. This study rather individually summarizes three studies that each utilize a vast amount of varying central and peripheral vascular measures and therefore lacks a concise takeaway from these studies meeting the inclusion criteria.

Are the conclusions drawn adequately supported by the results presented in the review?

No, the conclusion is over-reported. There is reported evidence in the included studies that state null findings and lack of significant change in response to Bikram interventions.
Additionally, the outcomes outlined in Table 1 do not align with those mentioned in the Abstract or Results, specifically LVET and RPP. RPP is a metric of cardiac oxygen consumption, while LVET is a metric for cardiac function. Although metrics of any portion of the cardiovascular tree are often related, this paper should either delineate peripheral vascular metrics or central cardiovascular metrics or provide a deduction into the causal improvement of one of these aspects on the other.
The limitations are well-understood and well reported.
The future outcomes are also exceptionally written.

Are the rationale for, and objectives of, the Systematic Review clearly stated?

Partly
Are sufficient details of the methods and analysis provided to allow replication by others?

No
Is the statistical analysis and its interpretation appropriate?

Partly
Are the conclusions drawn adequately supported by the results presented in the review?

Partly

References

1. Patil SG, Patil SS, Aithala MR, Das KK: Comparison of yoga and walking-exercise on cardiac time intervals as a measure of cardiac function in elderly with increased pulse pressure.Indian Heart J. 2017; 69 (4): 485-490 PubMed Abstract | Publisher Full Text
2. Patil SG, Aithala MR, Das KK: Effect of yoga on arterial stiffness in elderly subjects with increased pulse pressure: A randomized controlled study.Complement Ther Med. 2015; 23 (4): 562-9 PubMed Abstract | Publisher Full Text
3. Saptharishi L, Soudarssanane M, Thiruselvakumar D, Navasakthi D, et al.: Community-based Randomized Controlled Trial of Non-pharmacological Interventions in Prevention and Control of Hypertension among Young Adults.Indian J Community Med. 2009; 34 (4): 329-34 PubMed Abstract | Publisher Full Text

Competing Interests

Two of the three studies that met the authors' inclusion criteria are first authored by a previous mentor during my graduate work. However, I have no affiliation to the included studies within the current systematic review manuscript.

Reviewer Expertise

Exercise Physiology, Diabetes, Cardiovascular Disease, Cellular Biology, Endothelial Function, Translational Medicine

I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above.

Respond to this report

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[1] 1. Shimokawa H, Satoh K: Vascular function. Arteriosclerosis, Thrombosis, and Vascular Biology. Vol. 34. . Lippincott Williams and Wilkins; 2014; pp. 2359–2362.

[2] 2. Biomarkers as drug development tools: discovery, validation, qualification and use.

[3] 3. Chan SY, Mancini GBJ, Kuramoto L, et al.: The prognostic importance of endothelial dysfunction and carotid atheroma burden in patients with coronary artery disease. J. Am. Coll. Cardiol. 2003 Sep 17; 42(6): 1037–1043. Publisher Full Text

[4] 4. Oliveros E, Patel H, Kyung S, et al.: Hypertension in older adults: Assessment, management, and challenges. Clinical Cardiology. Vol. 43. . John Wiley and Sons Inc.; 2020; pp. 99–107.

[5] 5. Hunter SD, Tarumi T, Dhindsa MS, et al.: Hatha yoga and vascular function: Results fromcross-sectional and interventional studies. J. Bodyw. Mov. Ther. 2013 Jul; 17(3): 322–327. PubMed Abstract | Publisher Full Text

[6] 6. Daugherty A, Fisher EA, Taubman MB, et al.: Forty-Year Anniversary of Arteriosclerosis, Thrombosis, and Vascular Biology. Arterioscler. Thromb. Vasc. Biol. 2021; 41(9): 2353–2356. PubMed Abstract | Publisher Full Text | Free Full Text

[7] 7. Hunter SD, Dhindsa MS, Cunningham E, et al.: The Effect of Bikram Yoga on Arterial Stiffness in Young and Older Adults. J. Altern. Complement. Med. 2013 Dec; 19(12): 930–934. Publisher Full Text

[8] 8. Vlachopoulos C, Aznaouridis K, Stefanadis C: Prediction of Cardiovascular Events and All-Cause Mortality With Arterial Stiffness. A Systematic Review and Meta-Analysis. J. Am. Coll. Cardiol. 2010 Mar 30; 55(13): 1318–1327. Publisher Full Text

[9] 9. Hunter SD, Laosiripisan J, Elmenshawy A: Effects of heated and thermoneutral yoga interventions on arterial stiffness in middle-aged adults. Complement. Ther. Med. 2018 Oct 1; 40: 113–115. PubMed Abstract | Publisher Full Text

[10] 10. Fleg JL, Strait J: Age-associated changes in cardiovascular structure and function: a fertile milieu for future disease. Heart Fail. Rev. 2012 Sep 2; 17(4–5): 545–554. PubMed Abstract | Publisher Full Text | Free Full Text

[11] 11. Lee HY, Oh BH: Aging and arterial stiffness. Circ. J. 2010; 74: 2257–2262. Publisher Full Text

[12] 12. Laurent S, Boutouyrie P, Asmar R, et al.: Aortic Stiffness Is an Independent Predictor of All-Cause and Cardiovascular Mortality in Hypertensive Patients.2001. Reference Source

[13] 13. Patil SG, Patil SS, Aithala MR, et al.: Comparison of yoga and walking-exercise on cardiac time intervals as a measure of cardiac function in elderly with increased pulse pressure. Indian Heart J. 2017 Jul 1; 69(4): 485–490. PubMed Abstract | Publisher Full Text | Free Full Text

[14] 14. Alexander GK, Innes KE, Selfe TK, et al.: “More than I expected”: Perceived benefits of yoga practice among older adults at risk for cardiovascular disease. Complement. Ther. Med. 2013 Feb; 21(1): 14–28. PubMed Abstract | Publisher Full Text | Free Full Text

[15] 15. Cramer H, Lauche R, Haller H, et al.: Effects of yoga on cardiovascular disease risk factors: A systematic review and meta-analysis. Int. J. Cardiol. 2014 May 1; 173(2): 170–183. PubMed Abstract | Publisher Full Text

[16] 16. Das K, Dhanakshirur G, Patil S, et al.: Comparison of the effects of yoga and lifestyle modification on grade-I hypertension in elderly males: A preliminary study. Int. J. Clin. Exp. Physiol. 2014; 1(1): 68. Publisher Full Text

[17] 17. Bharshankar JR, Bharshankar RN, Deshpande VN, et al.: Effect of yoga on cardiovascular system in subjects above 40 years. Indian J. Physiol. Pharmacol. 2003; 47: 202–206. PubMed Abstract

[18] 18. Gurunathrao S, If TD, If TD, et al.: Comparison of yoga and walking-exercise on cardiac time intervals as a measure of cardiac function in elderly with increased pulse pressure. Indian Heart J. 2017; 69(4): 485–490. Publisher Full Text

[19] 19. Hunter SD, Dhindsa MS, Cunningham E, et al.: ScienceDirect The effect of Bikram yoga on endothelial function in young and middle-aged and older adults. J. Bodyw. Mov. Ther. 2016; 6–10.

Can yoga show better vascular outcomes than regular exercise among office workers: a scoping review

Abstract

Keywords

Introduction

Methods

Identifying the research question

Table 1. Research question and designated outcome.

Identification of relevant studies

Table 2. MeSH terms.

Figure 1. Data extraction flow chart.

Results

Table 3. Study classification and its characteristics.

Yoga and vascular function

Bikrama yoga and FMD

Heated and thermoneutral yoga in arterial stiffness

Discussion

Yoga and walking exercise

Endothelial function

Pulse wave velocity

Conclusion

Limitation

Future outcomes

Data availability

References

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