Yoga

Yoga and Other Exercises Improve Body Image and Psychological Well-Being

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Yoga and Other Exercises Improve Body Image and Psychological Well-Being

 

By John M. de Castro, Ph.D.

 

“Overall, practicing yoga can have a profound impact on improving body image, but it depends how it is approached by the individual. When you treat yoga as a tool for body appreciation, healthy movement, and inner reflection, it helps improve body image and mental health.” – Tara Caguait

 

The media is constantly presenting idealized images of what we should look like. These are unrealistic and unattainable for the vast majority of people. But it results in most everyone being unhappy with their body.  This can lead to problematic consequences. In a number of eating disorders there’s a distorted body image. This can and does drive unhealthy behaviors. As a treatment mindfulness has been shown to improve eating disorders.

 

In the media, yoga is portrayed as practiced by lithe beautiful people. This is, of course, unrealistic and potentially harmful. But yoga is also an exercise that tends to improve the body and it has been shown to improve body image and psychological health. It is unclear whether it is the exercise provided by yoga practice that promotes psychological health and a healthy body image or to components specific to yoga practice.

 

In today’s Research News article “Yoga, Dance, Team Sports, or Individual Sports: Does the Type of Exercise Matter? An Online Study Investigating the Relationships Between Different Types of Exercise, Body Image, and Well-Being in Regular Exercise Practitioners.” (See summary below or view the full text of the study at: https://www.frontiersin.org/articles/10.3389/fpsyg.2021.621272/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_1616048_69_Psycho_20210504_arts_A )  Marshin and colleagues recruited adults online and had them complete measures of amount and type of exercise, body size, body image, body dissatisfaction, eating disorders, physical efficacy, physical activity, positive and negative emotions, and depression.

 

They found that the participants who engaged in regular exercise had significantly lower body dissatisfaction, perceived body weight, and depression and significantly higher positive emotions than sedentary individuals. They also found that there were no significant differences in any of the outcome variables for regular exercise practitioners of yoga, ballroom dance, team sports, or individual sports.

 

These findings are correlational, so no conclusions can be reached regarding causation. But it is clear that people who exercise have a better image of their bodies and better mental health than sedentary individuals. The fact that there were no significant differences between practitioners of different types of exercise including yoga suggests that exercise of any type is associated with greater satisfaction with the body and better mood. Yoga practice has been shown to improve body image and positive emotions and lower depression. The present findings suggest that these benefits of yoga practice are due to the exercise and not to the other components of yoga practice.

 

So, yoga and other exercises improve body image and psychological well-being.

 

“Individuals who are dissatisfied with their body image are at a higher risk for eating disorders, depression, and low self-esteem. When diversity and inclusivity are encouraged, yoga may have an important role to play in supporting healthy feelings toward body image.” – Lacey Gibson

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Marschin V and Herbert C (2021) Yoga, Dance, Team Sports, or Individual Sports: Does the Type of Exercise Matter? An Online Study Investigating the Relationships Between Different Types of Exercise, Body Image, and Well-Being in Regular Exercise Practitioners. Front. Psychol. 12:621272. doi: 10.3389/fpsyg.2021.621272

 

Physical activity, specifically exercising, has been suggested to improve body image, mental health, and well-being. With respect to body image, previous findings highlight a general benefit of exercise. This study investigates whether the relationship between exercising and body image varies with the type of exercise that individuals preferentially and regularly engage in. In addition, physical efficacy was explored as a potential psychological mediator between type of exercise and body image. Using a cross-sectional design, healthy regular exercise practitioners of yoga, ballroom dance, team sports, or individual sports as well as healthy adults reporting no regular exercising were surveyed. Body image and its different facets were assessed by a set of standardized self-report questionnaires, covering perceptual, cognitive, and affective body image dimensions particularly related to negative body image. In addition, participants were questioned with regard to mental health. Participants were 270 healthy adults. Descriptive statistics, measures of variance (ANOVA), and multiple linear regression analysis with orthogonal contrasts were performed to investigate differences between the different exercise and non-exercise groups in the variables of interest. In line with the hypotheses and previous findings, the statistic comparisons revealed that body dissatisfaction (as one important factor of negative body image) was most pronounced in the non-exercise group compared to all exercise groups [contrast: no exercise versus exercise (all groups taken together)]. Physical efficacy, as assessed with a standardized questionnaire, mediated the difference between type of exercise (using contrasts) and body image including perceptual, cognitive, and affective body image dimensions. The findings shed light on so far less systematically investigated questions regarding the relationship between types of exercise, like yoga and ballroom dance, and body image. The results underscore the relevance of considering possible influencing factors in exercise research, such as the perception of one’s physical efficacy as a mediator of this relationship.

https://www.frontiersin.org/articles/10.3389/fpsyg.2021.621272/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_1616048_69_Psycho_20210504_arts_A

 

Mindfulness Training Increases the Use of Yoga and Meditation to Cope with the Covid-19 Lockdown

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Mindfulness Training Increases the Use of Yoga and Meditation to Cope with the Covid-19 Lockdown

 

By John M. de Castro, Ph.D.

 

“mindfulness is one tool that can help promote mental wellness throughout the COVID-19 pandemic and beyond.” – Julie Dunne

 

Mindfulness training has been shown to improve health and well-being in healthy individuals. It has also been found to be effective for a large array of medical and psychiatric conditions, either stand-alone or in combination with more traditional therapies. The COVID-19 pandemic has challenged the mental and physical health of the population. It has created intense stress both for frontline workers but also for people simply isolating at home. Mindfulness is known to decrease the psychological and physical responses to stress. So, mindfulness training may be helpful in coping with the mental and physical challenges resulting from the lockdown during the the COVID-19 pandemic.

 

In today’s Research News article “Developing Resilience During the COVID-19 Pandemic: Yoga and Mindfulness for the Well-Being of Student Musicians in Spain.” (See summary below or view the full text of the study at: (https://www.frontiersin.org/articles/10.3389/fpsyg.2021.642992/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_1616048_69_Psycho_20210504_arts_A ) Bartos and colleagues recruited Spanish college music students who enrolled in 1-hour per week mindfulness course and those who did not. The course ran from November 2019 to May 2020. In march 2020 a nationwide lockdown was initiated and the mindfulness course switched to online. The students were asked whether during Covid-19 lockdown they received psychological help, had setbacks, health changes, the nature of health changes, changes in physical, psychological, and sleep quality during the lockdown, and any practices engaged in during the lockdown and the nature of the practices.

 

They found that the students who experienced mindfulness training were significantly more likely to practice yoga and meditation to improve their health and well-being during the lockdown than the control participants. They also indicated that they received greater benefits from the practices. Almost all of the mindfulness trained participants engaged in these practices while only about a half of the control participants did.

 

It should be noted that there wasn’t random assignment of students to groups. Rather, the groups were formed by the selections of the students. This can result in different kinds of students in the two groups. It is possible that students who were likely to use yoga and meditation as coping mechanisms would be much more likely to choose to participate in a mindfulness course.

 

The Covid-19 lockdown provided a natural experiment that the researchers took advantage of to investigate the impact of mindfulness training on the students’ well-being during the lockdown. The findings support the efficacy of mindfulness training in improving the likelihood that yoga and meditation will be used as coping strategies and that these practices produce greater perceived benefits.

 

So, mindfulness training increases the use of yoga and meditation to cope with the covid-19 lockdown.

 

“Introducing a mindfulness and meditation practice during this pandemic has the potential to complement treatment and is a low-cost beneficial method of providing support with anxiety for all.” – C. Behan

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Bartos LJ, Funes MJ, Ouellet M, Posadas MP and Krägeloh C (2021) Developing Resilience During the COVID-19 Pandemic: Yoga and Mindfulness for the Well-Being of Student Musicians in Spain. Front. Psychol. 12:642992. doi: 10.3389/fpsyg.2021.642992

 

Here, we report on a quasi-experimental study to explore the applicability and perceived benefits of the CRAFT program, which is based on mindfulness, yoga, positive psychology, and emotional intelligence, to improve higher education student musicians’ health and well-being during the lockdown. A subset of student musicians at a Higher Conservatory of Music in Spain followed the CRAFT program during the academic year 2019/2020, 1 h per week as part of their curriculum. Students enrolled in CRAFT-based elective subjects formed the CRAFT program group (n = 40), while other students represented the control group (n = 53). The onset of the national lockdown elicited by the COVID-19 pandemic occurred halfway through the program, which was subsequently delivered in an online format. We administered an online survey to explore the effect that the exposure to the CRAFT program had in terms of how participants dealt with various health and well-being concerns arising from the COVID-19 lockdown. There was a significantly higher proportion of proactive participants in the CRAFT program group, 92%, than in the control group, 58%, in terms of implementing practices to improve their health and well-being during the lockdown. Additionally, significantly more participants acknowledged perceived benefits from their practices in the CRAFT program group, 78%, than in the control group, 52%. Among proactive participants, yoga/meditation was the most implemented in the CRAFT program group, followed by exercise, and other yoga/meditation practices, whereas in the control group, exercise and Alexander technique-based practices were the most applied. In the CRAFT program group, the highest rate of perceived benefits was from yoga/meditation CRAFT-based practices, 51%, followed by exercise, 32%, and other yoga/meditation practices, 27%, whereas in the control group, benefits were reported by 29% of exercising participants and 16% for those having practiced the Alexander technique. A similar pattern was observed when excluding participants with previous yoga/meditation experience. This study revealed how participants can independently apply learned skills from the CRAFT program in response to a naturally occurring life event of unprecedented global impact, suggesting that previous exposure to mindfulness and yoga is likely to have a beneficial effect on how young adults react towards exceptionally stressful conditions.

https://www.frontiersin.org/articles/10.3389/fpsyg.2021.642992/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_1616048_69_Psycho_20210504_arts_A

 

Improve the Physical and Psychological Health of Patients with Cardiac Arrhythmias with Yoga

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Improve the Physical and Psychological Health of Patients with Cardiac Arrhythmias with Yoga

 

By John M. de Castro, Ph.D.

 

“Exercise that revs up your heart rate isn’t the only kind of physical activity that can help prevent or manage heart disease. The calming exercise of yoga is good for the heart, too.” – Johns Hopkins Medicine

 

Cardiovascular disease is the number one killer, claiming more lives than all forms of cancer combined. Lifestyle changes have proved to be quite effective in reducing the risk of cardiovascular disease. These include quitting smoking, weight reduction, improved diet, physical activity, and reducing stresses. Contemplative practices, such as meditation, tai chi, and yoga, have also been shown to be helpful for heart health. These practices have also been shown to be helpful for producing the kinds of other lifestyle changes needed such as smoking cessation, weight reduction and stress reduction. Yoga is a mindfulness practice that has been shown to improve physical well-being and cardiovascular health.

 

“An arrhythmia is a problem with the rate or rhythm of the heartbeat. During an arrhythmia, the heart can beat too fast, too slowly, or with an irregular rhythm. When a heart beats too fast, the condition is called tachycardia. When a heart beats too slowly, the condition is called bradycardia.” (NIH). Arrythmias if untreated could lead to heart failure, stroke, cardiac arrest and sudden infant death. So, it is very important to identify treatments for arrhythmias. Research on the ability of yoga practice to treat arrhythmias has been accumulating, So, it makes sense to step back and review what has been learned on the ability of yoga to treat heart arrhythmia.

 

In today’s Research News article “A Review on Role of Yoga in the Management of Patients with Cardiac Arrhythmias.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8023436/ )  Sharma and colleagues review and summarize the published research on the effects of yoga practice on heart arrhythmia and its symptoms. They found 6 published research studies.

 

They report that the published research studies found that yoga practice significantly reduced the number of both symptomatic and non-symptomatic atrial fibrillation events and ventricular repolarization dispersion indices. There were also significant decreases in resting heart rate and blood pressure. The patients’ psychological well-being was also improved by yoga practice with significant decreases in depression and anxiety and significant increases in quality of life,

 

The results of this review indicates that yoga practice is a safe and effective treatment for patients with cardiac arrhythmias, improving both the physical and psychological manifestations of arrhythmias (paroxysmal atrial fibrillation, ventricular tachyarrhythmia, and palpitation). Although long-term follow-up was not included, the observed improvements produced by yoga practice would predict that there would be a lessened occurrence of cardiovascular disease and an increase in longevity.

 

So, improve the physical and psychological health of patients with cardiac arrhythmias with yoga.

 

“In the patients with cardiac arrhythmias, pranayama yoga therapy has been shown to reduce the ventricular repolarization dispersion thereby lowering the risk of developing malignant ventricular arrhythmias and sudden cardiac death. In heart failure patients, yoga therapy resulted in reduction in heart rate and blood pressure due to improved HRV, increased vagal tone and decreased sympathetic tone.” – Krishna Akella

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Sharma, G., Mooventhan, A., Naik, G., & Nivethitha, L. (2021). A Review on Role of Yoga in the Management of Patients with Cardiac Arrhythmias. International journal of yoga, 14(1), 26–35. https://doi.org/10.4103/ijoy.IJOY_7_20

 

Abstract

Evidence suggests that yoga is safe and effective in improving various risk factors, quality of life (QoL), and psychological burden that is related to arrhythmia. However, this is the first-ever systematic review performed to report the role of yoga in arrhythmia. We have performed a literature search using Cochrane Library, Medline/PubMed, Web of Science Core Collection, and IndMED electronic databases up to 3, January 2018. Of 240 articles, 6 potentially eligible articles were identified and included in the review. Results showed that yoga could be considered an efficient adjuvant in reducing arrhythmia (paroxysmal atrial fibrillation, ventricular tachyarrhythmia, and palpitation) related health problems; blood pressure, heart rate, depression and anxiety scores; and in improving health-related QoL of arrhythmia patients. However, there is a lack of randomized controlled trials and a clear mechanism behind the effect of yoga; studies had relatively a small sample size and different yoga protocols.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8023436/

 

Improve Lymphedema Symptoms Among Breast Cancer Survivors with Yoga Therapy

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Improve Lymphedema Symptoms Among Breast Cancer Survivors with Yoga Therapy

 

By John M. de Castro, Ph.D.

 

“Research in breast cancer patients has shown that yoga may be able to help: improve physical functioning, reduce fatigue, reduce stress, improve sleep, improve quality of life.” – Vicki Flannery

 

Because of great advances in treatment, many patients today are surviving cancer. But cancer survivors frequently suffer from a range of persistent psychological and physical residual symptoms that  impair their quality of life. A common side effect of cancer treatment is breast cancer-related lymphedema. It “comprises of a set of pathological conditions, in which protein-rich fluid accumulates in soft tissues because of lymphatic flow interruption. BCRL is an agglomeration of symptoms such as swelling of arm, decreased physical functioning and body motion, altered sensation in limbs, and fatigue accompanied by psychological stress.” A safe and effective treatments for Lymphedema is needed.

 

Mindfulness training and exercise have been shown to help with general cancer recovery. Mindfulness practices have been shown to improve the residual symptoms in cancer survivors.  Yoga is both an exercise and a mindfulness practice that has also been shown to be helpful with the residual symptoms in cancer survivors, the psychological and physical ability to deal with cancer treatment and improves sleep. The research on yoga practice as a treatment for patients recovering from breast cancer with Lymphedema has been accumulating. It is thus reasonable to take a step back and summarize what has been learned.

 

In today’s Research News article “Managing Lymphedema, Increasing Range of Motion, and Quality of Life through Yoga Therapy among Breast Cancer Survivors: A Systematic Review.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8023442/ )  Saraswathi and colleagues review and summarize the published research of the effects of yoga practice on the Lymphedema with breast cancer survivors. They identified 7 published studies.

 

They report that the published studies used a variety of yoga styles and found that yoga therapy was safe and produced positive benefits for the symptoms of Lymphedema with breast cancer survivors. In particular, there were significant improvements in the patients’ quality of life, range of motion, musculoskeletal symptoms, and survival. This suggests that yoga therapy is a safe and effective means of reducing the suffering of these cancer survivors. The authors note, though, that the studies were in general small and a large randomized control trial with an active control condition is needed.

 

So, improve lymphedema symptoms among breast cancer survivors with yoga therapy.

 

“When you’re in recovery or treatment for breast cancer, the medication and treatments come with many side effects that can take an unwanted toll on your body and spirit. . . One such therapy has already been proven to help breast cancer survivors and patients — yoga.” – Rocky Mountain Cancer Center

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Saraswathi, V., Latha, S., Niraimathi, K., & Vidhubala, E. (2021). Managing Lymphedema, Increasing Range of Motion, and Quality of Life through Yoga Therapy among Breast Cancer Survivors: A Systematic Review. International journal of yoga, 14(1), 3–17. https://doi.org/10.4103/ijoy.IJOY_73_19

 

Abstract

Lymphedema is a common complication of breast cancer treatment. Yoga is a nonconventional and noninvasive intervention that is reported to show beneficial effects in patients with breast cancer-related lymphedema (BCRL). This study attempted to systematically review the effect of yoga therapy on managing lymphedema, increasing the range of motion (ROM), and quality of life (QOL) among breast cancer survivors. The review search included studies from electronic bibliographic databases, namely Medline (PubMed), Embase, and Google Scholar till June 2019. Studies which assessed the outcome variables such as QOL and management of lymphedema or related physical symptoms as effect of yoga intervention were considered for review. Two authors individually reviewed, selected according to Cochrane guidelines, and extracted the articles using Covidence software. Screening process of this review resulted in a total of seven studies. The different styles of yoga employed in the studies were Iyengar yoga (n = 2), Satyananda yoga (n = 2), Hatha yoga (n = 2), and Ashtanga yoga (n = 1). The length of intervention and post intervention analysis ranged from 8 weeks to 12 months. Four studies included home practice sessions. QOL, ROM, and musculoskeletal symptoms showed improvement in all the studies. Yoga could be a safe and feasible exercise intervention for BCRL patients. Evidence generated from these studies was of moderate strength. Further long-term clinical trials with large sample size are essential for the development and standardization of yoga intervention guidelines for BCRL patients.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8023442/

 

Yoga Improves Resident Physician Psychological Health But Doesn’t Appear to be Feasible and Acceptable.

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Yoga Improves Resident Physician Psychological Health But Doesn’t Appear to be Feasible and Acceptable.

 

By John M. de Castro, Ph.D.

 

“Slammed by long and unpredictable hours, heavy clinical workloads, fatigue and limited professional control, many medical residents experience stress and even burnout. And surveys indicate this burnout can seriously impact physician well-being and patient care outcomes.” – Jennifer Huber

 

Stress is epidemic in the western workplace with almost two thirds of workers reporting high levels of stress at work. In high stress occupations, like healthcare, burnout is all too prevalent. Burnout is the fatigue, cynicism, emotional exhaustion, sleep disruption, and professional inefficacy that comes with work-related stress. It is estimated that over 45% of healthcare workers experience burnout. It not only affects the healthcare providers personally, but also the patients, as it produces a loss of empathy and compassion. Burnout, in fact, it is a threat to the entire healthcare system. Currently, over a third of healthcare workers report that they are looking for a new job. Hence, burnout contributes to the shortage of doctors and nurses.

 

Preventing burnout has to be a priority. Unfortunately, it is beyond the ability of the individual to change the environment to reduce stress and prevent burnout. So, it is important that methods be found to reduce the individual’s responses to stress; to make the individual more resilient when high levels of stress occur. Contemplative practices have been shown to reduce the psychological and physiological responses to stress and improve well-being. Indeed, mindfulness has been shown to be helpful in treating and preventing burnout, increasing resilience, and improving sleep. Yoga is a mind-body practice that includes mindfulness and exercise. Yoga practice has been shown to improve the symptoms of burnout. But it is unclear whether it would be feasible and effective for resident physicians.

 

In today’s Research News article “Evaluation of a Yoga-Based Mind-Body Intervention for Resident Physicians: A Randomized Clinical Trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7961714/ ) Loewenthal and colleagues recruited resident physicians and randomly assigned them to a wait-list control condition or to receive 1-hour, once a week for 6-weeks yoga training with daily home practice. They completed a questionnaire regarding the feasibility of the program. They were also measured before and after training and 2-months later for psychological health, including mindfulness, resilience, perceived stress, professional fulfillment, depression, anxiety, sleep disturbance, and resident well-being.

 

The participants rated the feasibility and acceptability of the program as low and they averaged attending only 1.93 of the 6 sessions with no one completing all 6 sessions. They found that the yoga group had significant increases in mindfulness, resilience, professional fulfillment, and resident well-being and significant decreases in anxiety, perceived stress, and sleep disturbance. While the wait-list group did not.

 

These efficacy findings are similar to those reported in other studies that yoga training results in increases in mindfulness, resilience, and well-being and significant decreases in anxiety, perceived stress, and sleep disturbance. But the program was very disappointing in feasibility and acceptability. Resident physicians are pressed for time and stressed and may not have the time too attend classes and practice yoga. Other mindfulness programs, particularly those implemented online have been found to be feasible, acceptable, and effective for health care workers. They would appear to be preferable to yoga for resident physicians.

 

So, yoga improves resident physician psychological health but doesn’t appear to be feasible and acceptable.

 

“So often we treat others’ bodies and minds, yet often neglect our own. While we encourage our patients to roll out their mats and settle into their asanas, we can remember to do it ourselves. When we treat our stress and anxiety, we will be better able to treat our patients.” – Julia Michie Bruckner,

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Loewenthal, J., Dyer, N. L., Lipsyc-Sharf, M., Borden, S., Mehta, D. H., Dusek, J. A., & Khalsa, S. (2021). Evaluation of a Yoga-Based Mind-Body Intervention for Resident Physicians: A Randomized Clinical Trial. Global advances in health and medicine, 10, 21649561211001038. https://doi.org/10.1177/21649561211001038

 

Abstract

Background and Objective

Mind-body interventions (MBIs) have been shown to be effective individual-level interventions for mitigating physician burnout, but there are no controlled studies of yoga-based MBIs in resident physicians. We assessed the feasibility of a yoga-based MBI called RISE (resilience, integration, self-awareness, engagement) for residents among multiple specialties and academic medical centers.

Methods

We conducted a waitlist controlled randomized clinical trial of the RISE program with residents from multiple specialty departments at three academic medical centers. The RISE program consisted of six weekly sessions with suggested home practice. Feasibility was assessed across six domains: demand, implementation, practicality, acceptability, adaptation, and integration. Self-reported measures of psychological health were collected at baseline, post-program, and two-month follow-up.

Results

Among 2,000 residents contacted, 75 were assessed for eligibility and 56 were enrolled. Forty-four participants completed the study and were included in analysis. On average, participants attended two of six sessions. Feasibility of in-person attendance was rated as 28.9 (SD 25.6) on a 100-point visual analogue scale. Participants rated feasibility as 69.2 (SD 26.0) if the program was offered virtually. Those who received RISE reported improvements in mindfulness, stress, burnout, and physician well-being from baseline to post-program, which were sustained at two-month follow-up.

Conclusion

This is the first controlled study of a yoga-based MBI in residents. While the program was not feasible as delivered in this pilot study, initial analyses showed improvement in multiple measures of psychological health. Residents reported that virtual delivery would increase feasibility.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7961714/

 

Improve Adolescent Scoliosis with Select Yoga Poses

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Improve Adolescent Scoliosis with Select Yoga Poses

 

By John M. de Castro, Ph.D.

 

“Yoga can be very helpful for those with scoliosis, particularly given the combination of flexibility and core stabilization needed to perform yoga poses properly.” – Sara Lindberg

 

Scoliosis is a sidewise curvature of the spine that occurs in about 3% of adolescents. It develops most frequently in a growth spurt just prior to puberty. Most cases are mild and can be treated with a brace to stop the curve from increasing. But more serious cases can be disabling and may be treated with surgery.

 

There is a need for safe and effective treatments for scoliosis. Yoga practice combines mindfulness practice with exercise and has been shown to have a myriad of health benefits including the relief of chronic low-back pain. Many forms of yoga focus on the proper alignment of the spine, which could directly address the spinal curvature of scoliosis. But care must be taken as some yoga poses have the potential to exacerbate the spinal curvature.

 

In today’s Research News article “Isometric Yoga-Like Maneuvers Improve Adolescent Idiopathic Scoliosis-A Nonrandomized Control Trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7917413/ )  Fishman recruited adolescents less than 21 years of age with scoliosis and had them either receive treatment as usual, or yoga practice employing the side-plank pose for a lumbar curve, the half-moon and floating side plank poses for a thoracic curve, and or a side-plank, half-moon, and floating side plank poses for a Thoracolumbar curve. The yoga group was instructed to practice daily for 5 months and hold each pose for as long as they could. Instruction occurred either in person or over the internet. X-rays were taken of their spines before and after treatment.

 

They found that in the yoga group 49% of the lumbar and thoracolumbar curves and 29% of the thoracic curves had significant improvement while none of the control group did. In person and internet instruction were equally effective but compliance was better with in person instruction.

 

These results suggest that practicing a select set of yoga poses appears to be effective in treating scoliosis in adolescents. It is important that the right poses are used. Many yoga poses could well exacerbate the problem. In this study the side-plank, half-moon, and floating side plank poses were found to produce significant improvements.

 

So, improve adolescent scoliosis with select yoga poses

 

 

“But yoga and scoliosis don’t necessarily go hand in hand. While many poses are perfectly safe for scoliotic spines — and some even provide proven benefits — many others can make the curves worse. To safely perform yoga for scoliosis relief, it’s important to differentiate between asanas that can help and those that pose a risk.” – Clayton Stitzel

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Fishman L. M. (2021). Isometric Yoga-Like Maneuvers Improve Adolescent Idiopathic Scoliosis-A Nonrandomized Control Trial. Global advances in health and medicine, 10, 2164956120988259. https://doi.org/10.1177/2164956120988259

 

Abstract

Objective

Assess therapeutic value of specific yoga poses for thoracic and lumbar adolescent idiopathic scoliosis (AIS) taught in office or Internet.

Study Design

Nonrandomized control trial: Fifty-six adolescents (mean age 14.0 years; mean Risser 3.0) were recruited from our clinic; 41 did the side-plank, the half-moon and elevated side plank poses as appropriate (treatment group) and 15 did not (controls). Thirty curves were treated in office, 30 via Internet. Curve change was evaluated by blinded serial Cobb angles, and analyzed using Mann-Whitney U, paired t-tests and χ2.

Results

Mean lumbar and thoracolumbar Cobb angle change was −9.2 (95% CI = −11.8, −6.6) in the treatment group and 5.4 (95% CI = 1.7, 9.0) in controls. Both treatment group improvement and deterioration in controls were significant (treatment group: paired t-test t = −7.1, df = 40, p = .000; controls: t = 3.2, df = 12, p = .008). Mean thoracic Cobb angle change was −7.1 (95% CI = −13.1, −1.2) in the treatment group and 9.3 (95% CI = 4.5, 14.6) in controls. Both changes were significant (paired t-test t = −3.3, df = 21, p = .022 for treatment group; t = 4.5, df = 5, p = .006 for controls). Nine Internet patients were non-compliant vs. 6 office patients. Office patients improved 1.6 degrees/month or 5.5%/month; Internet patients improved .72 degrees/month or 3.3%/month.

Conclusion

These yoga poses show promise for reversing adolescent idiopathic scoliosis. Telemedicine had greater non-compliance and lower efficacy but still produced patient improvement.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7917413/

 

Reduce Employee Stress with Workplace Yoga

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Reduce Employee Stress with Workplace Yoga

 

By John M. de Castro, Ph.D.

 

“Practicing yoga at the workplace teaches employees to use relaxation techniques to reduce stress and risks of injury on the job. Yoga at the workplace is a convenient and practical outlet that improves work performance by relieving tension and job stress.” – Shira Taylor Gura

 

Work is very important for our health and well-being. We spend approximately 25% of our adult lives at work. How we spend that time is immensely important for our psychological, social, and physical health. But, nearly 2/3 of employees worldwide are unhappy at work. This is partially due to work-related stress which is epidemic in the western workplace. Almost two thirds of workers reporting high levels of stress at work. This stress can result in impaired health and can result in burnout; producing fatigue, cynicism, and professional inefficacy.

 

To help overcome unhappiness, stress, and burnout, mindfulness practices have been implemented in the workplace. Mindfulness has been demonstrated to be helpful in reducing the psychological and physiological responses to stress and for treating and preventing burnout in a number of work environments. Yoga practice has the extra benefits of not only being mindfulness training but also as an exercise. The research has been accumulation. So, it makes sense to step back and summarize what has been learned about the effects of yoga practice in the workplace on employee stress levels.

 

In today’s Research News article “Effectiveness of Workplace Yoga Interventions to Reduce Perceived Stress in Employees: A Systematic Review and Meta-Analysis.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7739364/ ) Valle and colleagues review, summarize, and perform a meta-analysis of the published controlled research studies of the effectiveness of yoga practice in the workplace for the stress levels and psychological health of employees.

 

They identified 6 controlled trials with a total of 487 participants. They report that these published trials found that yoga interventions in the workplace produced significant reductions in the stress levels of the employees. This replicates previous studies that practicing yoga reduces stress. It is important that the yoga classes were held at work. This makes participation much more convenient, making it more likely. As a result, yoga in the workplace may be a very effective means of reducing stress and thereby reducing employee burnout.

 

So, reduce employee stress with workplace yoga.

 

“Yoga postures, slow, deep, yogic breathing has also shown to elicit a relaxation response which could contribute to a reduction in stress in the workplace.” – Lisa Rappaport

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Della Valle, E., Palermi, S., Aloe, I., Marcantonio, R., Spera, R., Montagnani, S., & Sirico, F. (2020). Effectiveness of Workplace Yoga Interventions to Reduce Perceived Stress in Employees: A Systematic Review and Meta-Analysis. Journal of functional morphology and kinesiology, 5(2), 33. https://doi.org/10.3390/jfmk5020033

 

Abstract

Work-related stress represents a relevant public health issue and solution strategies are mandatory. Yoga is a common approach to manage stress and its effectiveness has been extensively confirmed. Therefore, this study aims systematically to review the effectiveness of Yoga interventions carried out at workplace on work-related stress among employees and to assess their impact quantitatively. Springerlink, MEDLINE, PubMed, CINAHL, Web of Science, Scopus, Cochrane CENTRAL and PEDro databases were searched. Clinical trials comparing workplace Yoga interventions to control groups, and evaluating perceived stress as outcome measure, were assessed for eligibility. All forms and styles of Yoga were considered for the analysis. Out of 3392 initially identified, 6 studies were included in the meta-analysis; 266 participants practicing Yoga interventions at worksite were compared to 221 subjects in control group. Included studies showed “some concerns” about different domains of source of bias. Quantitative analysis showed an overall effect size of −0.67 [95% confidence interval (CI): −0.86, −0.49] in favor of Yoga intervention in reducing stress outcome measures. Hence, workplace Yoga interventions were more effective when compared to no treatment in work-related stress management. Further high-quality studies are needed to improve the validity of these results and to specify more characteristics of the Yoga intervention, such as style, volume, and frequency.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7739364/

 

Improve Physical Fitness and Quality of Life of Substance Abusers with Mind-Body Practices

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Improve Physical Fitness and Quality of Life of Substance Abusers with Mind-Body Practices.

 

By John M. de Castro, Ph.D.

 

“Available data suggest that mindfulness-based interventions may help significantly reduce the consumption of several substances including alcohol, cigarettes, opiates, and others.” – NCCIH Clinical Digest

 

Substance abuse is a major health and social problem. There are estimated 22.2 million people in the U.S. with substance dependence. It is estimated that worldwide there are nearly ¼ million deaths yearly as a result of illicit drug use which includes unintentional overdoses, suicides, HIV and AIDS, and trauma. Obviously, there is a need to find effective methods to prevent and treat substance abuse. There are a number of programs that are successful at stopping the drug abuse, including the classic 12-step program emblematic of Alcoholics Anonymous. Unfortunately, the majority of drug and/or alcohol abusers relapse and return to substance abuse.

 

Hence, it is important to find an effective method to treat substance abuse and prevent relapse but an effective treatment has been elusive. Most programs and therapies to treat addictions have poor success rates. Recently, mindfulness training has been found to be effective in treating addictions. Mind-Body practices such as yoga has been found to be effective in treating substance abuse and Tai Chi practice has also been found to improve addiction recovery.

 

In today’s Research News article “Long-Term Effects of Mind-Body Exercises on the Physical Fitness and Quality of Life of Individuals With Substance Use Disorder-A Randomized Trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7775308/ ) Zhu and colleagues recruited men who were being treated for a substance use disorder (Amphetamines). They were randomly assigned to receive either 20 minutes, 3 times daily, 5 days per week, for 3 months of mind-body exercise or recreational activities. The mind-body exercises were selected from Tai Chi, Qigong, and Yoga movements. They were measured before and after training and 3 months later for physical fitness, physical, mental, social, and physical symptoms quality of life.

 

They found that in comparison to baseline and the recreational activities group, the group that performed mind-body exercises had significant reductions in body mass index (BMI), systolic and diastolic blood pressure, and heart rate, and significant increases in sit-and-reach, cardiovascular endurance, and physical, mental, social, and physical symptoms quality of life. These improvements were present at the endo of training and 3 months later at follow-up.

 

The results are clear. Mind-body exercise significantly improved the physical fitness and psychological well-being of the participants. The form of exercise was unique containing components from Tai Chi, Qigong, and yoga practices. But previous research has demonstrated physical and psychological improvements in a variety of healthy and ill individuals with Tai Chi and Qigong and also yoga practices. So, it is not surprising that using selective components of these practices would also have these benefits. But the study is unique in applying these practices to men recovering from amphetamine abuse. Although not reported, it would be expected that these benefits would help them with recovery from substance use disorder.

 

So, improve physical fitness and quality of life of substance abusers with mind-body practices.

 

“What does this mean for treatment practice or for an addict in recovery? At their core, mind-body therapies improve overall mental and physical health while improving brain function.” – Constance Scharff

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Zhu, D., Jiang, M., Xu, D., & Schöllhorn, W. I. (2020). Long-Term Effects of Mind-Body Exercises on the Physical Fitness and Quality of Life of Individuals With Substance Use Disorder-A Randomized Trial. Frontiers in psychiatry, 11, 528373. https://doi.org/10.3389/fpsyt.2020.528373

 

Abstract

Background: Mind-body exercises (MBE) are sequences of low to medium-intensity activities that benefit healthy performers physically and mentally. In contrast to the unmodified application of traditional tai chi, qi gong, or yoga in the healthy population, MBEs are typically tailored for individuals with substance abuse disorder (SUD). Despite numerous applications in practice, the detailed effects of tailor-made MBEs for SUD are unclear.

Objectives: This study aimed to analyze and compare changes in the physical fitness and quality of life of individuals with SUD that underwent conventional or tailor-made MBEs.

Methods: A total of 100 subjects obtained from the Shanghai Mandatory Detoxification and Rehabilitation Center with SUD were randomly assigned into two groups. The subjects in the experimental group (n = 50) practiced tailored MBE for 60 min a day, five times a week, for 3 months. The subjects (n = 50) in the control group were treated with conventional rehabilitation exercises with the same intervention protocol. The outcomes of fitness and quality of life for drug addiction were measured at the beginning and after 3 and 6 months by a questionnaire (QOL-DA). A two-way repeated measure analysis of variance was applied to compare the difference of treatments in the two groups.

Results: Statistically significant differences for the experimental group were found in systolic (p < 0.01, η2 = 0.124) and diastolic blood pressure (p < 0.01, η2 = 0.097), pulse (p < 0.01, η2 = 0.086), vital capacity (p < 0.05, η2 = 0.036), flexibility (p < 0.01, η2 = 0.143), and aerobic endurance (p < 0.01, η2 = 0.165). Results of the QOL-DA showed statistically significant differences between the experimental and control groups in total score (p < 0.01, η2 = 0.158) with greater effects on the former.

Conclusions: This study provided evidence that tailored MBE could lead to remarkable effects with regard to blood pressure, vital capacity, flexibility, and aerobic endurance in comparison with conventional rehabilitation methods.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7775308/

 

Different Aspects of Yoga Practice Affect the Psychological Benefits

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Different Aspects of Yoga Practice Affect the Psychological Benefits

 

By John M. de Castro, Ph.D.

 

“Most styles of yoga are based on the same basic yoga poses (called asanas), however the experience of one style can be radically different than another.” – DoYoga

 

Yoga training has been shown to improve health and well-being. It has also been found to be effective for a large array of medical and psychiatric conditions, either stand-alone or in combination with more traditional therapies. But there are a wide variety of different yoga training techniques and practices. Although the benefits of yoga practices in general are well studied there is little scientific research comparing different components of yoga practices and the benefits.

 

In today’s Research News article “Exploring how different types of yoga change psychological resources and emotional well-being across a single session.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7081324/ ) Park and colleagues recruited adults who had attended at least 5 yoga classes. There were 3 different practice sites engaged in a variety of types of yoga; Hatha yoga: Ashtanga, Baptiste, Bikram, Forrest, Iyengar, Kripalu, Kundalini, Pranayama, Restorative, Vinyasa Flow, and Yin. Before and after a 60-minute yoga class they were measured for psychological resources (mindfulness, body awareness, self-transcendence, peacefulness and contentment, social connectedness), and exercise induced feelings (positive emotions, revitalization, tranquility, and exhaustion). After the class they were measured for properties of yoga, physical taxation, and therapist warmth.

 

In comparison to before the yoga class, afterward there were significant increases exercise induced feelings (positive emotions, revitalization, tranquility, and decreased exhaustion), psychological resources (mindfulness, body awareness, self-transcendence, spirituality, and social connectedness). In addition, the greater the increase in positive emotions, revitalization, and tranquility, the greater the increase in mindfulness, self-transcendence, spirituality, and social connectedness. In addition, the greater the decrease in exhaustion the greater the increase in mindfulness, self-transcendence, spirituality, and social connectedness.

 

They also investigated different aspects of the yoga practice and their relationships to psychological resources and emotions. They found that the higher the levels of the restorative aspects of the yoga practice the greater the changes in self-transcendence, spirituality, and tranquility, the higher the levels of the breathwork aspects of the yoga practice the greater the changes in body awareness and self-transcendence, and the higher the levels of the therapist warmth the greater the changes in self-transcendence and positive engagement.

 

These results are correlative and need to be interpreted with caution. But they provide interesting clues as to how yoga practice may produce some of its benefits. It increases the psychological resources available to the participants and improves their emotions. They also showed that the larger the increases in psychological resources produced by yoga practice the greater the improvements in emotions. Finally, they showed that restorative and breathwork aspects of yoga practice and the therapist warmth were most related to improvements.

 

Much more research is needed. But this study suggests that yoga practice strengthens the psychological resources of the practitioners and these are related to improved emotions. It also demonstrates that certain aspects of yoga practice that are differently emphasized in different styles of yoga, particularly restorative and breathwork aspects of yoga practice and the therapist warmth, may contribute to yoga’s benefits.

 

So, different aspects of yoga practice affect the psychological benefits.

 

“figure out your intention—do you want to do yoga to improve your health; lessen stress; increase mindfulness; gain strength; lose weight or relieve pain? Once you have the answer to this question you will know the practice that is right for you.” – Femina

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Park, C. L., Finkelstein-Fox, L., Groessl, E. J., Elwy, A. R., & Lee, S. Y. (2020). Exploring how different types of yoga change psychological resources and emotional well-being across a single session. Complementary therapies in medicine, 49, 102354. https://doi.org/10.1016/j.ctim.2020.102354

 

Abstract

Objectives:

Yoga demonstrates beneficial effects in many populations, yet our understanding of how yoga brings about these effects is quite limited. Among the proposed mechanisms of yoga are increasing psychological resources (mindfulness, body consciousness, self-transcendence, spiritual peace, and social connectedness) that may bring about salutary effects on emotional wellbeing. Further, yoga is a complex practice comprising meditation, active and restorative postures, and breathwork; however little is known about how different components may affect mechanisms. We aimed to determine how an acute session of yoga (and its specific components) related to pre- to post- session changes in proposed mechanisms (psychological resources) and whether those changes were associated with positive changes in emotions.

Design:

144 regular yoga practitioners completed measures of mindfulness, body consciousness, self-transcendence, social connectedness, spiritual peace, and exercise-induced emotions (positive engagement, revitalization, tranquility, exhaustion) immediately before and after a yoga session (N=11 sessions, each a different type of yoga). Perceived properties of each yoga session, exercise exertion and engagement with the yoga teacher were assessed immediately following the session.

Results:

Pre- to post- yoga, levels of positive emotions (engagement, tranquility and revitalization) increased while exhaustion decreased. Further, all psychological resources increased and closely tracked improved emotions. Additionally, aspects of the yoga session correlated with changes in psychological resources (mechanisms) and emotions.

Conclusions:

Yoga may influence multiple psychological mechanisms that influence emotional well-being. Further, different types of yoga may affect different mechanisms. Results can inform yoga interventions aiming to optimize effects through specific mechanisms such as mindfulness or spirituality.

Highlights

  • To gain a better understanding of how yoga brings about beneficial effects, we examined changes in psychological resources and emotions across a single session of yoga.
  • All five psychological resources (mindfulness, body consciousness, self-transcendence, spiritual peace, and social connectedness) increased from pre-to-post yoga session, and all emotions (positive engagement, revitalization, tranquility and exhaustion) improved.
  • Further, improvements in emotions were associated with improvements in psychological resources.
  • Different styles of yoga were associated with differential improvements in psychological resources and emotions.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7081324/

 

Yoga Practitioners Have Better Psychological Health During the Covid-19 Lockdown

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Yoga Practitioners Have Better Psychological Health During the Covid-19 Lockdown

 

By John M. de Castro, Ph.D.

 

“the well understood underlying mechanisms for the use of yoga for stress reduction and immune modulation shall be considered as the basis for its complimentary role in the management of an infectious condition like COVID-19.“ – H. R. Nagendra

 

Yoga practice has been shown to improve health and well-being in healthy individuals. It has also been found to be effective for a large array of medical and psychiatric conditions, either stand-alone or in combination with more traditional therapies. The COVID-19 pandemic has challenged the mental and physical health of the population. It has created intense stress both for frontline workers but also for people simply isolating at home. Yoga practice is known to decrease the psychological and physical responses to stress. So, yoga practice may be helpful in coping with the mental and physical challenges resulting from the COVID-19 pandemic and lockdown.

 

In today’s Research News article “Yoga an effective strategy for self-management of stress-related problems and wellbeing during COVID19 lockdown: A cross-sectional study.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7875402/ ) Sahni and colleagues recruited adults online during the Covid-19 lockdown. They separated the participants into three groups; those who practice yoga, other spiritual practices, and non-practitioners. The participants completed online measures of Covid-19 perceptions, depression, anxiety, perceived stress, general well-being, resilience, peace of mind, and emotion regulation.

 

They found that in comparison to the spiritual practices and non-practitioners, the yoga practitioners had a significantly higher level of Covid-19 perception of personal control, and significantly lower levels of illness concern and emotional impact of COVID19. In addition, the yoga practitioners had significantly lower levels of depression, anxiety, and perceived stress and significantly higher levels of peace of mind. well-being, and cognitive reappraisal strategies of emotion regulation. In general, they found that the longer that the yoga practitioners had practiced, the greater the benefits.

 

This study examined existing groups and there wasn’t random assignment. Hence, the findings could be due to systematic differences between people who choose to engage in yoga, other spiritual practices, or no practice. But previous controlled research has demonstrated that yoga practice causes decreased depression, anxiety, and perceived stress, and increased well-being. So, the difference seen here between groups probably represent the causal effects of yoga practice.

 

These results suggest that practicing yoga makes an individual more resistant to the deleterious psychological effects of the pandemic and the associated lockdown. It appears to improve the practitioners’ psychological well-being, peace of mind, attitude toward the pandemic, and ability to regulate emotions. In addition, the greater the amount of yoga practice, the greater the benefits. These yoga-produced abilities may well underlie yoga practice’s positive impact on various diseases.

 

So, yoga practitioners have better psychological health during the Covid-19 lockdown.

 

“COVID-19 has caused levels of stress and anxiety to skyrocket and it’s (understandably) taking a toll on people’s mental health. One thing that can help? Yoga.”- CorePower Yoga

 

CMCS – Center for Mindfulness and Contemplative Studies

 

This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch

 

Study Summary

 

Sahni, P. S., Singh, K., Sharma, N., & Garg, R. (2021). Yoga an effective strategy for self-management of stress-related problems and wellbeing during COVID19 lockdown: A cross-sectional study. PloS one, 16(2), e0245214. https://doi.org/10.1371/journal.pone.0245214

 

Abstract

This cross-sectional research aims to study the effect of yoga practice on the illness perception, and wellbeing of healthy adults during 4–10 weeks of lockdown due to COVID19 outbreak. A total of 668 adults (64.7% males, M = 28.12 years, SD = 9.09 years) participated in the online survey. The participants were grouped as; yoga practitioners, other spiritual practitioners, and non-practitioners based on their responses to daily practices that they follow. Yoga practitioners were further examined based on the duration of practice as; long-term, mid-term and beginners. Multivariate analysis indicates that yoga practitioners had significantly lower depression, anxiety, & stress (DASS), and higher general wellbeing (SWGB) as well as higher peace of mind (POMS) than the other two groups. The results further revealed that the yoga practitioners significantly differed in the perception of personal control, illness concern and emotional impact of COVID19. However, there was no significant difference found for the measure of resilience (BRS) in this study. Yoga practitioners also significantly differed in the cognitive reappraisal strategy for regulating their emotions than the other two groups. Interestingly, it was found that beginners -those who had started practicing yoga only during the lockdown period reported no significant difference for general wellbeing and peace of mind when compared to the mid- term practitioner. Evidence supports that yoga was found as an effective self- management strategy to cope with stress, anxiety and depression, and maintain wellbeing during COVID19 lockdown.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7875402/