An online yoga program appears to be effective, feasible and safe for patients with irritable bowel syndrome (IBS), according to a new report.
Participants reported decreases in IBS-related symptoms and improvements in quality of life, fatigue, and perceived stress.
“IBS affects more than 15% to 20% of the North American population, and despite our advances in the field, we have very few options to offer our patients,” said Maitreyi Raman, MD, associate professor of medicine at the University of Calgary. , Canada, says Medscape Medical News.
“Often we focus on treating the symptoms but not the underlying cause,” said Raman, director of Alberta’s Collaboration of Excellence for Nutrition in Digestive Diseases. “With advances in the gut microbiome and evolving science on the brain-gut axis, mind-body interventions may offer a therapeutic option that patients can use to improve the overall course of their disease.”
The study was published online in the American Journal of Gastroenterology.
Online Yoga Program vs IBS Tips Only
IBS often involves alterations in the gut-brain axis and can be affected by psychological or physiological stress, the study authors write. Previous studies have shown that in-person yoga programs can manage IBS symptoms and improve physiological, psychological, and emotional health.
During the COVID-19 pandemic, yoga programs have had to shift to a virtual format — a delivery method that may remain relevant due to limited healthcare resources. However, the effectiveness, feasibility, and safety of virtual yoga for people with IBS were unknown.
Raman and colleagues conducted a two-arm, randomized controlled clinical trial at the University of Calgary between March 2021 and December 2022. All 79 participants were not blinded by the arms of the trial – an online yoga program or an advice-only control group.
Eligible participants had a diagnosis of IBS, had scored at least 75 out of 500 points on the IBS Symptom Severity Scale (IBS-SSS) for mild IBS, and were taking stable doses of IBS medication. They were asked to continue their current therapies during the study, but were not started on any new medications or made any major changes to their diet or exercise habits.
The yoga program was based on Upa Yoga, a subtype of Hatha Yoga developed by the Isha Foundation of Inner Sciences. The program was delivered by a certified Isha Foundation yoga facilitator and included directional movements, neck rotations, breathing practices, breath observation and mantra meditation with aum/om chanting.
The online courses for three to seven participants were delivered in 60-minute sessions over 8 weeks. Participants were also asked to practice daily at home with the support of yoga videos.
The counseling-only control group included a 10-minute video with general education on IBS, the mind-gut connection in IBS, and the role of mind-body therapies in managing IBS. Attendees received a list of IBS-related resources from the Canadian Digestive Health Foundation, a link to an IBS patient support group, and information about physical activity guidelines from the World Health Organization .
The research team looked for a primary endpoint of at least a 50 point reduction on the IBS-SSS, which is considered clinically meaningful.
They also measured secondary outcomes, such as quality of life, anxiety, depression, perceived stress, COVID-19-related stress, fatigue, somatic symptoms, self-compassion, and intention. to practice yoga.
Of the 79 participants, 38 were randomized to the yoga program and 41 were randomized to the counseling-only control group. The average age was 45 years old. Most (92%) were women and 81% were white. The mean duration of IBS since diagnosis was 11.5 years.
The overall mean IBS-SSS was moderate at 245.3 at the start of the program and dropped to 207.9 at week 8. The score decreased from 255.2 to 200.5 in the yoga group and from 236.1 to 213.5 in the control group. The difference between the groups was 32 points, which was not statistically significant, although symptom improvement began after 4 weeks in the yoga group.
In the yoga group, 14 participants (37%) achieved the goal of a 50 or more point decrease compared to eight participants (20%) in the control group. These 22 “responders” reported improvements in IBS symptoms, quality of life, perceived stress, and COVID-19-related stress.
Specifically, among the 14 yoga group responders, there were significant improvements in IBS symptoms, quality of life, fatigue, somatic symptoms, self-compassion, and COVID-related stress. -19. In the control group, there were significant improvements in IBS symptoms and COVID-19-related stress.
Using an intention-to-treat analysis, the research team found that group yoga improved quality of life, fatigue, and perceived stress. In the control group, improvements were seen only in COVID-19-related stress.
No significant improvement was found in anxiety or depression between groups, although changes in depression scores were in favor of the yoga group. Intention to practice yoga dropped in both groups over the study period, but was not associated with actual minutes of yoga practice or change in IBS-SSS scores.
“We saw a surprising improvement in quality of life,” Raman said. “Although we talk about quality of life as an important parameter, it can be difficult to show it in studies, so it was a great finding to demonstrate in this study.”
The yoga intervention was feasible in terms of adherence (79%), attrition rate (20%) and high program satisfaction, the researchers write. Safety has been demonstrated by the absence of any adverse events.
Future program considerations
Raman and his colleagues are interested in understanding the mechanisms underlying the effectiveness of mind-body interventions. They also plan to test the virtual yoga program in a mobile app, called LyfeMD, which aims to support patients with digestive diseases through evidence-based dietary programs and mind-body interventions, such as guided meditation, breathing exercises and cognitive behavioral therapy. .
“We know that patients seek out every resource possible,” Raman said. “Our next goal is to better understand how an app-based intervention can be effective, even without a live instructor.”
Future studies should also consider clinicians’ perspectives, she noted. In previous studies, Raman and his colleagues have found that doctors are willing to recommend yoga as a treatment option for patients, but some are unsure how to prescribe a recommended dose, frequency, or type of yoga.
“When treating patients with IBS, it’s important to think broadly and creatively about all of our treatment options,” said Elyse Thakur, PhD, clinical health psychologist at Atrium Health Gastroenterology and Hepatology in Charlotte, NL. North Carolina.
Thakur, who was not involved in this study, specializes in the psychology of gastrointestinal health. She and her colleagues use many complementary and alternative medicine options with patients.
“We have to remember that people may react differently to available treatment options,” she said. “Understanding the evidence is imperative so that we can have productive conversations with our patients about benefits and harms, as well as potential benefits and limitations.”
Am J Gastroenterol. Published online November 25, 2022. doi:10.14309/ajg.0000000000002052. Summary
The study did not receive a specific grant from a funding agency. The authors and Thakur have declared no relevant financial relationship.
Carolyn Crist is a health and medical journalist who reports on the latest studies for Medscape, MDedge, and WebMD.
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