Individuals suffering from vestibular diseases usually experience dizziness and difficulty with vision, balance, and mobility. ¹ Unilateral and peripheral vestibular diseases (UPVD) affect only one side of the vestibular system (unilateral) and only the portion of the system located outside the brain (peripheral, which is part of the inner ear). ^{1 , 2}

Even though dizziness is a frequent complaint, clinicians typically have trouble diagnosing and treating it. They invest significantly on diagnostics but receive little in the way of conclusive results. ^{2 , 3} Vertigo is the delusional feeling of motion that occurs while a person is motionless and can occur within the body or in the surroundings. It is frequently accompanied by a whirling sensation, nausea, emesis, and diaphoresis. Chronic vertigo is characterized as persistent vertigo. ^{4 – 6} Recurrent episodes of vertigo are a hallmark of chronic vertigo. Recurrent spontaneous vertigo is frequently brought on by benign paroxysmal positional vertigo, Ménière’s syndrome, vertebra-basilar transient ischemic episodes, and migraine headaches. True labyrinthitis (sudden onset vertigo with hearing loss) and vestibular neuronitis (sudden onset vertigo without hearing loss) are monophasic illnesses that result in long-term disability. ⁴ Treatment is symptomatic, with antivertiginous and antiemetic medications used to alleviate symptoms. However, according to numerous investigations of the treatment of vertigo, none of the conventional medications have a proven curative or preventative benefit or are suitable for long-term palliative usage. ⁴

For the treatment of these conditions, the use of vestibular rehabilitation (VR), which combines various movement-based regimens, is growing. VR includes components such as intentionally inducing symptoms to “desensitize” the vestibular system, synchronizing eye and head movements, improving balance and walking abilities, and acquiring knowledge about the illness in order to cope better or engage in healthier lifestyles. ⁷

Studies, including double-blind placebo-controlled trials, have extensively validated the use of VR in a range of diseases linked with vertigo. ^{8 – 11} Except in a few rare instances (like BPPV treatment), these interventions are not “powerful” in the sense that their impact is usually small yet essential. ¹² A well-known and frequently used method of VR in chronic vertigo brought on by central compensation is the Cawthorne Cooksey exercises. ^{13 – 17} While consistent practice of these exercises delivers beneficial results in the long term, some patients find them tedious, leading to a lack of compliance. ^{15 – 17} Balance activities like Yoga, Tai Chi, and martial arts are excellent alternatives to these occasionally dull exercises because they incorporate plenty of head movement and visual stimulation. ¹⁸

Yoga is a popular kind of exercise that promotes a healthy lifestyle and relieves a variety of human ailments. It originated in India and has since expanded throughout the world. For thousands of years, people have practiced yoga. It is made up of old presumptions, observations, and concepts about the relationship between the mind and the body that have recently been validated by modern medicine. The health benefits of yoga have been thoroughly researched, including the Yoga Postures (Asanas), Yoga Breathing (Pranayama), and Meditation. ⁶ Yoga includes relaxation, which may be beneficial to individuals who experience anxiety due to imbalance or dizziness. Yoga also has the advantage of being accessible to people of virtually any age. Even though yoga is less expensive than personalized therapy, its efficacy has not been directly compared to that of tailored therapy. The individuals who are most suitable for them are probably those who have “graduated” from individual therapy. ¹⁹ The purpose of this study was to use Yoga Postures (Asanas) as part of VR by employing central compensation for peripheral vertigo. In addition to enhancing focus, concentration, and a general sense of well-being, some yoga positions may also aid with balance impairment and dizzy spells by offering VR, which may be helpful in the treatment of vertigo. The aim of this research has been to evaluate the effectiveness of yoga as a vestibular rehabilitation activity to traditional Vestibular Rehabilitation (VR).

Fifty subjects were included in Group I (Yoga), fifty subjects in Group II (VRT), and fifty in group III (Control). The results were analyzed for 150 patients of the 85 (56.7%) were females 65 (43.3%) were males. In the yoga group 30 (60%) were females 20 (40%) were males in the VRT group 24 (48%) were females 26 (52%) were males and in the control group, 31 (62%) were females 19 (38%) were males respectively. The majority of the patients with giddiness were in the fourth to six decades of life. While most patients with the diagnosis of BPPV & Meniere’s were in the age group of 41-60 years, those with Labyrinthitis and Vestibular neuritis were in the age group of 21-40 years ( Table 1a). Two patients lost to follow-up in each of the three groups. Two patients did not come after the first-month follow-up for unknown reasons. Four patients missed after two months follow up of exercise session (one due to transport difficulty, three had to be shifted their locality for their occupation).

BPPV was the most common cause of peripheral vertigo (48.6%), followed by Meniere’s (35.1%) and Labyrinthitis or vestibular neuritis (13.2%) ( Table 1b). ²² The mean symptom duration was 15.76±7.67 months (12-72 months) for 150 patients.

The DHI-Physical at baseline mean±SD values between Yoga group (8.12±6.213), VRT group (6.96±4.802) and the control group (11.76±6.056), as shown in Table 2a, are observed to be different from each other. The DHI-Physical at 4 weeks mean±SD values between Yoga group (3.64±3.718), VRT group (3.6±3.747) and the control group (8.6±4.664), as shown in Table 3a. The DHI-Physical at 8 weeks mean±SD values between Yoga group (0.8±2.356), VRT group (0.42±0.906) and the control group (6.64±4.336), as shown in Table 4a. The DHI-Physical at 12 weeks mean±SD values between Yoga group (0.14±0.495), VRT group (0.1±0.505) and the control group (6±4.101), as shown in Table 5a. There was no statistical significance (mean difference, p value) between Yoga and VRT group (0.405, 1), statistical significance was noted between Yoga and Control group (-5.075, <.001) as well as VRT and Control group (-5.48, <.001). Based on the findings, all three groups were compared with each time point and it was found that there was a statistically significant difference (F=52, p<.001) between the 3 groups. When the groups were compared with each other, statistically significant difference (F=159.33, p<.001) were found throughout the time points. When the three groups were examined at various intervals, statistically insignificant (F=1.66, p=0.13) differences were found ( Table 2b and Figure 2a).

The DHI-Functional at baseline mean±SD values between Yoga group (17.92±4.642), VRT group (16.72±3.326) and the control group (20.4±4.832), as shown in Table 3a, are observed to be different from each other. The DHI-Functional at 4 weeks mean±SD values between Yoga group (9.68±9.68), VRT group (10.08±4.198) and the control group (15.48±3.829), as shown in Table 3a. The DHI-Functional at 8 weeks mean±SD values between Yoga group (1.52±3.247), VRT group (2.16±3.203) and the control group (12.898±3.721), as shown in Table 4a. The DHI-Functional at 12 weeks mean±SD values between Yoga group (0.1±0.416), VRT group (0.72±1.97) and the control group (12.48±4.564), as shown in Table 5a. There was no statistical significance (mean difference, p value) between Yoga and VRT group (-0.115, 1), statistical significance was noted between Yoga and Control group (-7.945, <.001) as well as VRT and Control group (-7.83, <.001). Based on the findings, all three groups were compared with each time point and it was found that there was a statistically significant difference (F=156, p<.001) between the 3 groups. When the groups were compared with each other, statistically significant difference (F=641.3, p<.001) were found throughout the time points. When the three groups were examined at various intervals, statistically significant (F=32.1, p<.001) differences were found ( Table 3b and Figure 2b).

The DHI-Emotional at baseline mean±SD values between Yoga group (17.96±3.928), VRT group (16.4±4.295) and the control group (18.68±4.688), as shown in Table 4a, are observed to be different from each other. The DHI-Emotional at 4 weeks mean±SD values between Yoga group (6.44±3.732), VRT group (6.92±4.375) and the control group (14.6±4.086), as shown in Table 3a. The DHI-Emotional at 8 weeks mean±SD values between Yoga group (0.8±2.65), VRT group (0.96±1.818) and the control group (12.0816±3.415), as shown in Table 4a. The DHI-Emotional at 12 weeks mean±SD values between Yoga group (0.08±0.566), VRT group (0.44±1.527) and the control group (11.6±3.681), as shown in Table 5a. There was no statistical significance (mean difference, p value) between Yoga and VRT group (0.14, 1), statistical significance was noted between Yoga and Control group (-7.86, <.001) as well as VRT and Control group (-8, <.001). Based on the findings, all three groups were compared with each time point and it was found that there was a statistically significant difference (F=189, p<.001) between the 3 groups. When the groups were compared with each other, statistically significant difference (F=674.2, p<.001) were found throughout the time points. When the three groups were examined at various intervals, statistically significant (F=40.1, p<.001) differences were found ( Table 4b and Figure 2c).

The DHI-Total at baseline mean±SD values between Yoga group (44±10.482), VRT group (40.08±6.797) and the control group (50.84±10.782), as shown in Table 5a, are observed to be different from each other. The DHI-Total at 4 weeks mean±SD values between Yoga group (19.76±9.812), VRT group (20.6±10.461) and the control group (38.68±8.977), as shown in Table 3a. The DHI-Total at 8 weeks mean±SD values between Yoga group (3.12±7.774), VRT group (3.54±5.011) and the control group (31.7551±7.965), as shown in Table 4a. The DHI-Total at 12 weeks mean±SD values between Yoga group (0.32±1.096), VRT group (1.26±3.312) and the control group (30.08±9.026), as shown in Table 5a. There was no statistical significance (mean difference, p value) between Yoga and VRT group (0.43, 1), statistical significance was noted between Yoga and Control group (-20.88, <.001) as well as VRT and Control group (-21.31, <.001). Based on the findings, all three groups were compared with each time point and it was found that there was a statistically significant difference (F=245, p<.001) between the 3 groups. When the groups were compared with each other, statistically significant difference (F=743.9, p<.001) were found throughout the time points. When the three groups were examined at various intervals, statistically significant (F=30.9, p<.001) differences were found ( Table 5b and Figure 2d).

This study evaluated the effectiveness of yoga as a vestibular rehabilitation strategy to standard Vestibular Rehabilitation (VR) in treating persistent peripheral vertigo. Over time, the utility of vestibular exercises for managing patients with chronic symptoms of positional vertigo and disequilibrium has been established. A customized vestibular rehabilitation treatment (VRT) program was developed to match the unique demands of each individual, while taking into account a greater understanding of the vestibular system’s function and adaptation. VRT requires active patient participation and can be delivered through supervised outpatient workouts or home exercise regimens. ⁹ Vestibular exercises are overseen and progressed by therapists, and suitable outcome measures are used to assess the patient’s progress. A VRT program typically lasts between four and ten weeks.

There is strong evidence that vestibular rehabilitation is both safe and effective in the treatment of unilateral peripheral vestibular impairment. ¹⁰ Vestibular rehabilitation therapy (VRT) has shown significant benefit in individuals with a stable unilateral peripheral vestibular loss and partial central compensatory. Symptoms such as skew deviation, nystagmus, vertigo, oscillopsia, disequilibrium, nausea, and vomiting often disappear after an acute vestibular dysfunction, such as vestibular neuritis, as the central nervous system (CNS) achieves acute compensation during the first 24 to 72 hours. The cerebellum influences this compensation, which requires releasing cerebellar inhibition to establish symmetrical tonic firing rates in second-order neurons originating in the vestibular nuclei. ⁷ While some patients recover quickly and spontaneously, individuals who have partial compensation or decompensation of the CNS to the vestibular system after the acute lesion may continue to have motion-induced vertigo, oscillopsia, and disequilibrium. ¹¹ Individuals in such instances may benefit from a personalized term of VRT guided by a skilled vestibular therapist. ³

Horak and colleagues found that after a 6-week intervention period involving treatment groups (vestibular rehabilitation therapy or VRT, general conditioning exercise, and medication), all three approaches led to a reduction in dizziness symptoms in individuals with chronic unilateral vestibular loss (UVL). However, only VRT demonstrated a significant increase in balance. ¹² According to Mira E’s review, improving the quality of life for individuals with peripheral vestibular diseases is a main goal of therapeutic therapies. ¹¹ Furthermore, Gottshall and colleagues determined that vestibular therapy in individuals with Meniere’s illness resulted in considerable improvements in balance function, as measured by objective and self-reported tests. ¹³

Persistent dizziness is commonly associated with considerable handicap, impairment, and psychological distress, and it frequently causes secondary concerns such as anxiety, hyperventilation, and neck pain as a result of keeping a stiff head position in order to avoid triggering head movements. ⁸ Chronic dizziness requires a multimodal approach, with rehabilitation and simple counseling being required for all patients. ^{14 , 15} Although exercises produce favorable outcomes when practiced consistently over time, some individuals may find them monotonous, leading to compliance concerns. Engaging in balance exercises such as Yoga, Tai Chi, martial arts, or games involving significant head movement and visual stimulation is another option worth investigating. Both Tai Chi and Yoga contain relaxing elements that might be beneficial, particularly for people with anxiety. Although their effectiveness has not been directly compared, these activities are often more cost-effective than individualized therapy. They are most likely appropriate for people who have finished personalized therapy. ²

Yoga, which originated in India and is now extensively practiced worldwide, has become a popular type of exercise that provides a holistic approach to a healthy lifestyle as well as treatment from a variety of human ailments. Yoga, which has been practiced for over 5,000 years, incorporates breathing techniques, physical postures, and meditation. While yoga began as a spiritual practice inside Hinduism, a subset of the discipline known as Asana has grown in popularity in the Western world primarily as a physical fitness program. Yoga is frequently isolated from Hinduism or spirituality in Western contexts, serving only as a technique of preserving physical fitness and health. Clinical investigations are increasingly being conducted to determine the extent to which yoga helps psychological and emotional well-being. A PubMed search for “yoga and depression” yields 25 clinical trials concentrating on the association between yoga and emotional and psychological health published during 2007, 2008, and the first quarter of 2009. Moreover, three review articles and three systematic reviews were published over this time period to study the effects of various combinations of yoga, meditation, and yogic breathing on mental health.

Yoga incorporates ancient theories and principles concerning the relationship between the mind and body, which modern medicine is now proving through extensive research. Extensive research has been done to investigate the health benefits of many parts of yoga, such as yoga postures (asanas), yoga breathing (pranayama), and meditation. The material on the benefits of Yoga Poses is divided into three categories: physiological, psychological, and scientific comparisons to the benefits of regular exercise. ¹⁶ Yoga’s physiological benefits include the establishment of stable autonomic nervous system equilibrium, a drop in pulse rate, a reduction in respiratory rate, improved eye-hand coordination, a reduction in reaction time, and good effects on posture and balance. Yoga is connected with increased somatic and kinesthetic awareness, mood enhancement, enhanced subjective well-being, improved concentration, better memory, heightened attention, and an overall rise in well-being. These findings have been objectively examined and compared to the advantages of regular exercise. ^{17 , 18}

The purpose of this study was to investigate the use of Yoga Postures (Asanas) as a component of vestibular therapy for central compensation in cases with peripheral vertigo. The hypothesis proposed that various Yoga postures could not only aid in vestibular rehabilitation but also reduce dizzy episodes while improving focus, concentration, and overall well-being, hence assisting in vertigo recovery. Another advantage of yoga is that it is appropriate for individuals of all ages. The study aimed to assess the efficacy of yoga vs physiotherapy (VRT), using yoga poses chosen to promote optimal movement of the head, balance, and body for vestibular rehabilitation and central compensation. In an observer-blinded randomized controlled study, the Dizziness Handicap Inventory (DHI) was used. The results showed that, as shown in the tables, yoga was comparable to VRT in all of the evaluated criteria.

The advantage of yoga over physiotherapy or VRT is that it provides a wholesome and customized cure for giddiness. That means, apart from providing symptomatic relief of giddiness by vestibular rehabilitation, yoga also brings in additional proven benefits like general body relaxation, increased blood oxygenation, detoxification, and an overall sense of well-being. Being cheap and easy to learn, yoga could be an excellent substitute for the traditional VRT.

The trial was registered at the Clinical Trials Registry of India as CTRI/2019/03/017995 (Date of Registration: 08/03/2019; https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=MjUxMTQ=&Enc=&userName=CTRI/2019/03/017995). This clinical trial was registered retrospectively because regulatory institutional policies related to trial registration had changed after the study was completed. In order to meet the new regulations and guarantee that the trial was carried out openly and in compliance with current standards, this retrospective registration was required. The research was carried out in compliance with the Helsinki Declaration and received approval from the Kasturba Medical College and Kasturba Hospital Institutional Ethics Committee, Mangalore, MAHE (date of approval: 04/08/2009). This study adheres to the CONSORT guidelines. ²¹ The Institutional Ethics Committee (IEC) at our institution did not have a registration number at the time of the ethical registration process. As a result, even though our study was approved, no ethical approval number was issued. The participants provided their written informed consent to participate in the study. We confirm that we obtained written informed consent from all participants involved in our study to publish the study results and that all personal information will be kept confidential.