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      Yoga for Heart Failure: A Review and Future Research

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          Abstract

          Background:

          Complementary and alternative medicine is a rapidly growing area of biomedical inquiry. Yoga has emerged in the forefront of holistic medical care due to its long history of linking physical, mental, and spiritual well-being. Research in yoga therapy (YT) has associated improved cardiovascular and quality of life (QoL) outcomes for the special needs of heart failure (HF) patients.

          Aim:

          The aim of this study is to review yoga intervention studies on HF patients, discuss proposed mechanisms, and examine yoga's effect on physiological systems that have potential benefits for HF patients. Second, to recommend future research directions to find the most effective delivery methods of yoga to medically stable HF patients.

          Methods:

          The authors conducted a systematic review of the medical literature for RCTs involving HF patients as participants in yoga interventions and for studies utilizing mechanistic theories of stretch and new technologies. We examined physical intensity, mechanistic theories, and the use of the latest technologies.

          Conclusions:

          Based on the review, there is a need to further explore yoga mechanisms and research options for the delivery of YT. Software apps as exergames developed for use at home and community activity centers may minimize health disparities and increase QoL for HF patients.

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          Most cited references63

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          Trends in heart failure incidence and survival in a community-based population.

          The epidemic of heart failure has yet to be fully investigated, and data on incidence, survival, and sex-specific temporal trends in community-based populations are limited. To test the hypothesis that the incidence of heart failure has declined and survival after heart failure diagnosis has improved over time but that secular trends have diverged by sex. Population-based cohort study using the resources of the Rochester Epidemiology Project conducted in Olmsted County, Minnesota. Patients were 4537 Olmsted County residents (57% women; mean [SD] age, 74 [14] years) with a diagnosis of heart failure between 1979 and 2000. Framingham criteria and clinical criteria were used to validate the diagnosis Incidence of heart failure and survival after heart failure diagnosis. The incidence of heart failure was higher among men (378/100 000 persons; 95% confidence interval [CI], 361-395 for men; 289/100 000 persons; 95% CI, 277-300 for women) and did not change over time among men or women. After a mean follow-up of 4.2 years (range, 0-23.8 years), 3347 deaths occurred, including 1930 among women and 1417 among men. Survival after heart failure diagnosis was worse among men than women (relative risk, 1.33; 95% CI, 1.24-1.43) but overall improved over time (5-year age-adjusted survival, 43% in 1979-1984 vs 52% in 1996-2000, P<.001). However, men and younger persons experienced larger survival gains, contrasting with less or no improvement for women and elderly persons. In this community-based cohort, the incidence of heart failure has not declined during 2 decades, but survival after onset of heart failure has increased overall, with less improvement among women and elderly persons.
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            Yoga for depression: a systematic review and meta-analysis.

            Mind-body medical interventions are commonly used to cope with depression and yoga is one of the most commonly used mind-body interventions. The aim of this review was to systematically assess and meta-analyze the effectiveness of yoga for depression. Medline/PubMed, Scopus, the Cochrane Library, PsycINFO, and IndMED were searched through January 2013. Randomized controlled trials (RCTs) of yoga for patients with depressive disorders and individuals with elevated levels of depression were included. Main outcomes were severity of depression and remission rates, secondary outcomes were anxiety, quality of life, and safety. Twelve RCTs with 619 participants were included. Three RCTs had low risk of bias. Regarding severity of depression, there was moderate evidence for short-term effects of yoga compared to usual care (standardized mean difference (SMD) = -0.69; 95% confidence interval (CI) -0.99, -0.39; P < .001), and limited evidence compared to relaxation (SMD = -0.62; 95%CI -1.03, -0.22; P = .003), and aerobic exercise (SMD = -0.59; 95% CI -0.99, -0.18; P = .004). Limited evidence was found for short-term effects of yoga on anxiety compared to relaxation (SMD = -0.79; 95% CI -1.3, -0.26; P = .004). Subgroup analyses revealed evidence for effects in patients with depressive disorders and in individuals with elevated levels of depression. Due to the paucity and heterogeneity of the RCTs, no meta-analyses on long-term effects were possible. No RCT reported safety data. Despite methodological drawbacks of the included studies, yoga could be considered an ancillary treatment option for patients with depressive disorders and individuals with elevated levels of depression. © 2013 Wiley Periodicals, Inc.
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              Muscle Releases Alpha-Sarcoglycan Positive Extracellular Vesicles Carrying miRNAs in the Bloodstream

              In the past few years, skeletal muscle has emerged as an important secretory organ producing soluble factors, called myokines, that exert either autocrine, paracrine or endocrine effects. Moreover, recent studies have shown that muscle releases microRNAs into the bloodstream in response to physical exercise. These microRNAs affect target cells, such as hormones and cytokines. The mechanisms underlying microRNA secretion are poorly characterized at present. Here, we investigated whether muscle tissue releases extracellular vesicles (EVs), which carry microRNAs in the bloodstream under physiological conditions such as physical exercise. Using density gradient separation of plasma from sedentary and physically fit young men we found EVs positive for TSG101 and alpha-sarcoglycan (SGCA), and enriched for miR-206. Cytometric analysis showed that the SGCA+ EVs account for 1–5% of the total and that 60–65% of these EVs were also positive for the exosomal marker CD81. Furthermore, the SGCA-immuno captured sub-population of EVs exhibited higher levels of the miR-206/miR16 ratio compared to total plasma EVs. Finally, a significant positive correlation was found between the aerobic fitness and muscle-specific miRNAs and EV miR-133b and -181a-5p were significantly up-regulated after acute exercise. Thus, our study proposes EVs as a novel means of muscle communication potentially involved in muscle remodeling and homeostasis.
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                Author and article information

                Journal
                Int J Yoga
                Int J Yoga
                IJY
                International Journal of Yoga
                Medknow Publications & Media Pvt Ltd (India )
                0973-6131
                2231-2714
                May-Aug 2018
                : 11
                : 2
                : 91-98
                Affiliations
                [1] Department of Kinesiology, University of North Georgia, Oakwood, GA, USA
                [1 ] Morehouse School of Medicine, Atlanta, GA, USA
                [2 ] College of Education and Human Development at Georgia State University, Atlanta, GA, USA
                Author notes
                Address for correspondence: Dr. Paula R Pullen, Department of Physiology and CVRI, Morehouse School of Medicine, Atlanta, GA, USA. E-mail: prseffens@ 123456ung.edu
                Article
                IJY-11-91
                10.4103/ijoy.IJOY_24_17
                5934956
                29755216
                419d82a8-4b78-45e1-8001-75467dfe0de6
                Copyright: © 2018 International Journal of Yoga

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                : July 2017
                : September 2017
                Categories
                Review Article

                Complementary & Alternative medicine
                complementary medicine,exercise adherence,heart failure,quality of life,yoga therapy

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