|Year : 2023 | Volume
| Issue : 1 | Page : 3-11
Effect of yoga and mindfulness meditation on quality of life in computer users with chronic low back pain: A prospective randomized active control trial
Chametcha Singphow1, Satya Prakash Purohit2, Padmini Tekur1, Suman Bista3, Surya Narayan Panigrahy4, Balaram Pradhan2, Nagarathna Raghuram1
1 Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana, Bengaluru, Karnataka, India
2 Division of Yoga and Humanities, Swami Vivekananda Yoga Anusandhana Samsthana, Bengaluru, Karnataka, India
3 Department of Integrative Medicine, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
4 Department of Rehabilitation, Narayana Institute of Cardiac Sciences, Bengaluru, Karnataka, India
|Date of Submission||30-Apr-2022|
|Date of Acceptance||20-Nov-2022|
|Date of Web Publication||03-Feb-2023|
Dr. Satya Prakash Purohit
Department of Yoga and Humanity, Swami Vivekananda Yoga Anusandhana Samsthana, Prashanti Kutiram, Vivekananda Road, Kalluballu Post, Jigani, Anekal, Bengaluru - 560 105, Karnataka
Source of Support: None, Conflict of Interest: None
Background: Computer professionals are more prone to chronic low back pain (CLBP) as compared to the normal population. It has been reported that the 1-year prevalence of low back pain (LBP) was 23%38% in the normally active population, while it was 31%54% in computer users. Objective: To investigate the effect of yoga and mindfulness meditation on the quality of life (QOL) of computer users with CLBP. Materials and Methods: Eighty computer users (42.6 ± 8.45 years of age; suffering from CLBP since 5.20 ± 3.01 years; 51 males and 29 females) were recruited from Bengaluru, India. Participants were randomized into two groups: Yoga and mindfulness meditation/YM group (n = 40) and physical exercise/PE group (n = 40). The YM group practiced an integrated module comprising yoga postures and mindfulness meditation, and the PE group practiced PE designed for LBP. Both groups practiced 1 hour daily, 3 days a week for 16 weeks. WHO QOL-BREF and spinal flexibility (Straight Leg Raising [SLR]) were assessed at baseline and after 8 and 16 weeks. Results: Results of repeated measures-analysis of variance test showed that the scores on QOL physical health (diff = 12.43%, P < 0.001), psychological health (diff = 11.9%, P < 0.001), social relationships (diff = 15.66% P < 0.001), and environment (diff = 17.37% P < 0.001) were significantly higher in YM group as compared to PE group at the end of 16 weeks. Similarly, the scores on the SLR right leg (diff = 12.97%, P < 0.001) and SLR left leg score (diff = 11.71%, P < 0.001) were significantly higher in the YM group as compared to the PE group at the end of 16 weeks. Conclusion: Yoga with mindfulness meditation is significantly more effective in improving QOL and spinal flexibility in computer users with CLBP as compared to PE designed for LBP.
Keywords: Back pain, mindfulness, quality of life, spinal flexibility, yoga
|How to cite this article:|
Singphow C, Purohit SP, Tekur P, Bista S, Panigrahy SN, Pradhan B, Raghuram N. Effect of yoga and mindfulness meditation on quality of life in computer users with chronic low back pain: A prospective randomized active control trial. J Appl Conscious Stud 2023;11:3-11
|How to cite this URL:|
Singphow C, Purohit SP, Tekur P, Bista S, Panigrahy SN, Pradhan B, Raghuram N. Effect of yoga and mindfulness meditation on quality of life in computer users with chronic low back pain: A prospective randomized active control trial. J Appl Conscious Stud [serial online] 2023 [cited 2023 Mar 29];11:3-11. Available from: http://www.jacsonline.in/text.asp?2023/11/1/3/369131
| Introduction|| |
Back pain affects most adults and it is a common cause for seeking healthcare (Deyo et al., 2015). If a person experiences pain and difficulty in the lower back region below the medial margin and in the inferior gluteal folds, then it is called low back pain (LBP) (Koes et al., 2006). LBP has been considered one of the major causes of disability worldwide (Buchbinder et al., 2013). Most of the time, LBP is mechanical or nonspecific. Nonspecific LBP refers to LBP that arises somewhere from the spine, intervertebral disks, or surrounding soft tissues (Will et al., 2018). When the LBP lasts for more than 12 weeks, it is referred to as chronic LBP (CLBP) (Hartvigsen et al., 2018). The prevalence of CLBP is directly proportional to age as there are reduced physical activities as the age increases (Hartvigsen et al., 2018; Shemshaki et al., 2013). In recent studies conducted in the general population, it has been shown that the lifetime prevalence of LBP was 84% while that of CLBP was 23% and that of LBP with a major disability was 12% (Balagué et al., 2012). Similarly, the 1-year prevalence of LBP in the normally active population was reported to be 23%38%, whereas it was 31%54% in computer users (Oha et al., 2014). More recent studies have shown that the 1-year prevalence of LBP in computer users was 60% in a university setting (Stanam et al., 2019) and 40% among computer users in banks in Punjab, India (Moom et al., 2015).
The postural habits of the present-day automated life, and increased computer use, with reduced physical activity, are found to be responsible for the disruption of intervertebral tissues (Adams, 2018). Associated comorbidities and aging also contribute to the severity of CLBP (Hong and Shin, 2020). CLBP was also found to be associated with poor socio-economic status, psycho-social stresses, and depression (Hoy et al., 2010). Disability and pain are the most challenging factors in CLBP (Koes et al., 2006) which are further associated with various psychological factors (Serbic and Pincus, 2017). Hence, there is a significant association between pain, disability, and quality of life (QOL) in patients with CLBP (Kovacs et al., 2004).
Yoga therapy can be one of the effective treatment options for CLBP as studies demonstrated the adverse side effects associated with surgical procedures and long-term use of analgesic medication (Balagué et al., 2012). Yoga was basically invented to unite the individual consciousness with the universal consciousness; however, recent studies have revealed yoga's therapeutic benefits (Desai et al., 2015). The mindfulness meditation that deals with present-moment awareness originated from ancient Buddhist culture (Buchholz, 2015; Ludwig and Kabat-Zinn, 2008). The Anapanasati meditation (mindfulness of breathing) where-in practitioners continually focus on the awareness of the sensations of their breathing is one of the most common forms of Buddhist traditional mindfulness meditation (Chotipanich et al., 2021). Yoga offers a holistic approach through many mind-body techniques (Bhobe, 2000; Chaoul and Cohen, 2010) including mindfulness, breath regulation, maintenance in physical postures, relaxation, and meditation found to play an important role in treating various lifestyle diseases (Govindaraj et al., 2016).
Maintaining a static position for prolonged periods in unnatural sitting postures could cause inverse effects on intervertebral discs in computer users and their QOL is likely to decrease with the severity of the CLBP (Adedoyin et al., 2005). Several RCTs have demonstrated the benefits of integrated yoga in CLBP (Hartfiel et al., 2012; Sherman et al., 2005; P. Tekur et al., 2012; Tekur et al., 2008; Telles et al., 2009); however, studies seeing the effect of yoga on CLBP with long-term follow-ups are limited. Similarly, studies demonstrated yoga to be more effective in CLBP as compared to usual care or no care (Chang et al., 2016; Goode et al., 2016; Whitehead, 2018); however, there are limited studies that demonstrate the effectiveness of long-term yoga intervention as compared to physical exercise (PE). To the best of our knowledge, no study has investigated the long-term impact of yoga and mindfulness meditation on the QOL of computer users with CLBP. Therefore, the current study aims to investigate the effect of 16-week yoga and mindfulness meditation on the QOL in computer users with CLBP in comparison to PE.
| Materials and Methods|| |
Participants and sample size calculation
Eighty computer users (mean age = 42.6 ± 8.45 years; suffering from CLBP since 5.20 ± 3.01 years; 51 males and 29 females) were recruited for the study from Bengaluru, India. The calculated sample size for each group was 24 based on an earlier study using QOL as a variable with an effect size of 1.086 (power = 0.95 and alpha = 0.05) (Patil et al., 2018). Considering the possible attrition rate of up to 40% (Telles et al., 2016), the final sample size was set as 80; 40 subjects in each group (40 subjects in Yoga and Mindfulness Meditation group and 40 subjects in the PE group).
Subjects in the age range between 25 and 64 years (Hartfiel et al., 2012) who use a computer for their professional work for at least 6 h per day, 5 days a week (Telles et al., 2009) with current LBP persisting at least for 12 weeks with average pain intensity not less than 4 for the previous week on an 11-point numerical rating scale (Saper et al., 2014) with or without radiation to legs (Spitzer et al., 2007) were recruited for the study. Subjects having specific causes of LBP including spinal canal stenosis, spondylolisthesis grade II or more, ankylosing spondylitis, moderate-to-severe scoliosis, malignancy, and fracture were excluded (Saper et al., 2014). Those with severe obesity, life-threatening comorbid conditions, critical illness, recommended surgical intervention, and the inability of practicing yoga or exercise were also excluded from the study. Similarly, subjects having indications of serious spinal neurologic abnormality (difficulty passing urine; numbness around the back passage, genitals, or inner thighs; numbness, pins, and needles or weakness in both legs; unsteadiness on feet) were also excluded (Tilbrook et al., 2011). In addition, regular practitioners of yoga (at least once a week for one month or more in the past 6 months) and women with pregnancy were excluded.
The study was a prospective randomized active control trial with 16 weeks of follow-up investigating the effect of yoga and mindfulness meditation on the QOL in computer users with CLBP. The study physician recruited the eighty computer users with CLBP after screening them as per the selection criteria and indicated on a Recruitment form whether the patient is eligible for the study, without revealing the identity of the patient (through a random computer-generated number coding system). The allocation schedule of the patient was concealed from the physician. Using online randomization software, the project coordinator randomly assigned each patient to either the yoga and Mindfulness Meditation (YM) group (n = 40) or the PE group (n = 40). YM group practiced an integrated module comprising yoga postures and mindfulness meditation intervention for 16 weeks (1 h per day and 3 days per week). Similarly, the PE group practiced a PE module for the same duration. Assessments were performed at baseline, after 8 weeks, and after 16 weeks. The assessors and statisticians were unaware of the intervention assignment status of the subjects. The institutional ethical clearances from SVYASA Yoga University, Bengaluru were obtained before starting the trial. The trial was registered in Clinical Trial Registry India (CTRI/2020/12/029944).
All the assessments were done as per the standard guidelines. The assessments of the WHO QOL Scale - Brief Version (WHOQOL-BREF) and Straight Leg Raising (SLR) test were performed at baseline, after 8 weeks, and after 16 weeks for both groups.
WHO quality of life scale - brief version
The WHOQOL-BREF is a shorter version of the WHO QOL Scale - 100 Items (WHOQOL-100) comprising 26 items. The scale contains 26 items and provides a measure of an individual's perception of QOL for the 4 domains: physical health (7 items), psychological health (6 items), social relationships (3 items), and environment (8 items). The WHOQOL-BREF provides a valid, reliable, and brief assessment of the QOL (Garcia-Rea and LePage, 2010).
Straight leg raising test
A goniometer having two scales fixed at one end to a compass (calibrated in degrees) (Tekur et al., 2010) was used to measure SLR. The subject lies down on the back. The assessor stands on the right side of the couch, the goniometer is placed along the right leg on the couch with the centre of the compass supported firmly. Then, the right leg is raised passively without bending the knee until the subject starts getting pain. The outer scale of the goniometer is moved up along the right leg and the angle between the two scales is read on the compass. The same procedure is repeated for the left leg.
Yoga and mindfulness meditation group
The yoga and mindfulness meditation (YM) group practiced an integrated module comprising yoga postures and mindfulness meditation (Anapanasati/mindfulness of breathing) specifically designed to reduce stress, pain, and stiffness in LBP, 1 hour per day, 3 days per week for 16 weeks. The first 8 weeks of sessions were supervised, followed by the 8 weeks of home practice assisted by the guided audios and videos. They also got lifestyle advice based on yoga philosophy to improve mental and physical health [Table 1].
Physical exercise group
The PE group practiced a PE module designed to improve the mechanical structure of the lower spine (Tekur et al., 2010), 1 h per day, 3 days per week for 16 weeks. As in the Yoga group, the first 8-week PE sessions were supervised, followed by the 8-week home practice assisted by the guided videos and audio. The PE group was also given health education and lifestyle advice as per the conventional norms [Table 1].
The above intervention programs (YM and PE) were an add-on to conventional management. Regularity for the interventions was ensured by the yoga instructor and PE trainer within the corresponding groups.
Data were analyzed using the developed by International Business Machines Corporation (IBM), Armonk, NY, US (Stacks, 2009). Data were analyzed using the per-protocol approach. All the data were normally distributed. The analysis was performed by applying repeated Measures - Analysis of Variance with a between-subject fixed-effects factor with two levels (YM and PE) and time as a within-subject fixed-effects factor with three levels (baseline, 8 weeks, and 16 weeks).
| Results|| |
Out of 203 screened, 80 subjects satisfying selection criteria were randomized into two groups; YM (n = 40) and PE (n = 40). 77 participants (39 in YM group [mean age = 43.74 ± 7.26 years] and 38 in the PE group [mean age = 41.47 ± 9.53 years]) completed the study. The reasons for dropouts are presented in the trial profile [Figure 1]. There was no difference in demographic variables between the YM and PE groups [Table 2].
WHO quality of life scale - brief version
Within-group analysis [Table 3] showed that, in the YM group, the mean score of QOL physical health increased by 8.55% after 8 weeks (P < 0.001) and by 15.90% at 16 weeks (P < 0.001). Whereas, in the PE group, the score increased significantly only by 3.47% (P = 0. 01) after 16 weeks. In the YM group, the mean QOL psychological health score increased by 7.18% in 8 weeks (P < 0.001) and by 18.45% in 16 weeks (P < 0.001). Whereas, in the PE group, the score increased significantly only in 16 weeks by 6.55% (P < 0.001). In the YM group, the mean score on QOL social relationships increased by 8.75% in 8 weeks (P < 0.001) and by 18.68% in 16 weeks (P < 0.001). Whereas, the score did not change significantly in the PE group. In the YM group, the mean score of QOL environment health increased by 9.13% in 8 weeks (P < 0.001) and by 20.89% in 16 weeks (P < 0.001). Whereas, the score increased by 2.80% in 8 weeks (P = 0.006) and by 3.52% in 16 weeks (P = 0.036) in the PE group.
|Table 3: Changes in WHO quality of life score and straight leg raising test as per repeated measures analysis of variance with Bonferroni's correction|
Click here to view
The between-group analysis demonstrated the QOL physical health (P < 0.001), QOL psychological health (P = 0.002), QOL social relationships (P = 0.009), and QOL environment scores (P = 0.007) were significantly higher in the YM group as compared to PE group at the end of 8 weeks. Similarly, at the end of 16 weeks, the QOL physical health (P < 0.001), QOL psychological health (P < 0.001), QOL social relationships (P < 0.001), and QOL environment (P < 0.001) scores were significantly higher in YM group as compared to PE group [Table 3].
Straight leg raising test
Within-group analysis revealed that there was a significant improvement in SLR right leg score and SLR left leg score within both the YM group and PE group in 8 weeks as well as in 16 weeks (P < 0.001) [Table 3]. In the YM group, the mean SLR right leg score increased by 33.41% in 8 weeks and by 56.97% in 16 weeks. Whereas, the score increased by 23.73% in 8 weeks and by 44% in 16 weeks in the PE group. Similarly, the mean SLR left leg score increased by 32.24% in 8 weeks and by 56.07% in 16 weeks in the YM group. Whereas, the score increased by 24.16% in 8 weeks and by 44.36% in 16 weeks in the PE group.
The between-group analysis demonstrated the SLR right leg score (P = 0.013) and SLR left leg score (P = 0.011) were significantly higher in the YM group as compared to the PE group at the end of 8 weeks. Similarly, the SLR right leg score (P < 0.001) and SLR left leg score (P < 0.001) were significantly higher in the YM group as compared to the PE group at the end of 16 weeks [Table 3].
| Discussion|| |
The results of the current study demonstrated a significant group*time interaction effect on all four domains of quality of life and the straight leg rising test at 8 weeks as well as at 16 weeks favoring the YM group. In the current study, the QOL physical health score improved by 15.90% within the YM group and by 3.47% within the PH group in 16 weeks with a significant difference between groups favoring the YM group. The QOL psychological health score improved by 18.45% within the YM group and by 6.55% within the PH group in 16 weeks with a significant difference between groups favoring the YM group. Similarly, the QOL social relationships score improved by 18.68% within the YM group and by 3.02% within the PH group in 16 weeks with a significant difference between groups favoring the YM group. The QOL environment score improved by 20.89% within the YM group and by 3.52% within the PH group in 16 weeks with a significant difference between groups favoring the YM group.
In an earlier similar RCT using integrated yoga (asanas, pranayamas, meditation) in an inpatient setup, the physical health score improved by 27.55% within the yoga group and by 4.96% within the PE group after 1 week of the intensive residential program with significant difference between groups favoring yoga group (Tekur et al., 2010). In the study, the QOL psychological health score improved by 15.82% within the yoga group and by 1.75% within the PE with significant differences between groups favoring the yoga group. Similarly, the QOL social relationships score improved by 10.17% within the yoga group and by 3.45% within the PE group with significant differences between groups favoring the yoga group. The QOL environment score improved by 8.77% within the yoga group and by 0.45% within the PE group after 1 week of intervention with a significant difference between groups favouring the yoga group (Tekur et al., 2010). The results of the current study are in line with the earlier study. Significantly greater improvement in the yoga group was observed as compared to the PE group in both studies. The greater improvement in most of the QOL domains in our study may be because of the longer duration of intervention and the additional practice of mindfulness meditation as mindfulness practices are associated with enhancements in emotion regulation and positivity (Zeidan, 2015).
Similarly, another earlier RCT trying to see the effect of a 6-week intervention of integrated approach of yoga therapy on QOL in the nursing population suffering from CLBP, observed significant improvements in physical, psychological, and social domains of QOL in both yoga and PE group with significant difference between groups favouring yoga group (Patil et al., 2018). Whereas the environmental domain did not show significant improvements in either of the groups. In the study, the physical domain improved by 44.12% in the yoga group whereas it improved by 25.33% in the exercise group in 6 weeks. Similarly, the psychological domain improved by 97.7% in the yoga group whereas it improved by 20.89% in the exercise group. The social domain improved by 55.02% in the yoga group whereas it improved by 14.49% in the exercise group (Patil et al., 2018). The greater improvement in this earlier study as compared to the current study may be because of the intensive intervention protocol (supervised integrated yoga therapy sessions, 5 days per week, for 6 weeks). However, a significant improvement in the environmental domain only in the current study may be because of the present-moment awareness associated with mindfulness meditation.
In our study, the SLR right leg score improved by 56.97% within the YM group and by 44% within the PH group in 16 weeks with a significant difference between groups favouring the YM group. Similarly, the SLR left leg score improved by 56.07% within the YM group and by 44.36% within the PH group in 16 weeks with a significant difference between groups favouring the YM group. In an earlier similar study, the SLR right leg score improved by 31.14% within the yoga group and by 18.67% within the PE group after 1 week of intervention with a significant difference between groups favouring the yoga group (Tekur et al., 2010). Similarly, in the earlier study, the SLR left leg score improved by 28.38% within the yoga group and by 21.45% within the PE group after 1 week of intervention with a significant difference between groups favouring the yoga group (Tekur et al., 2010). The longer duration of PE may be the reason for the great improvement in the PE group too. The greater improvements in the yoga groups show the greater effectiveness of yogic practices over PE in both studies. Whereas, greater improvement within both groups in our study compared to the earlier study indicates the benefit of a longer duration of intervention.
As studies demonstrated, yoga may work through down-regulation of the sympathetic nervous system (SNS) and hypothalamic-pituitary-adrenal (HPA) axis (Ross and Thomas, 2010). The components such as awareness and relaxation may be the major contributors to the down-regulation of the SNS and HPA axis. Yogic postures also improve muscular strength and flexibility and promote respiratory and cardiovascular functions (Woodyard, 2011) which ultimately assist in better musculoskeletal health. Breath regulation also has the potential to bring the mind to the present moment and to reduce the level of stress associated with CLBP (Brown and Gerbarg, 2009). Breath regulation, meditation, and relaxation techniques after practicing yoga postures help to relax joints and muscles. Similarly, health benefits related to mindfulness meditation are associated with enhancements in mechanisms supporting cognitive control, emotion regulation, positive mood, and acceptance (Zeidan, 2015). Pain relief through mindfulness practices was found to be correlated with greater activation in brain regions associated with the cognitive modulation of pain, including the orbitofrontal, subgenual anterior cingulate, and anterior insular cortex (Zeidan et al., 2015). The pain relief is primarily associated with multiple neural mechanisms supporting the cognitive regulation of ascending nociceptive processing (↑ prefrontal [PFC] and ↑ perigenual anterior cingulate cortex [pgACC]; ↓thalamus) 136 and engages nonopioidergic endogenous systems (Adler-Neal et al., 2020). However, the physical and mechanical aspects of the yogic postures are quite similar to PE s which may be the reason that the PE s also demonstrate the similar kinds of improvements. PE is also considered to be a widely accepted method for maintaining holistic health and managing chronic illnesses including CLBP (Ross and Thomas, 2010). However, yoga along and mindfulness meditation intervention appeared to be more effective than PE on QOL and spinal flexibility in CLBP which may be because of various components of yogic practices other than the physical one. Hence, maintaining the postures, breath regulation, mindfulness, relaxation, etc., are the major components that separated yogic practices from exercises (Govindaraj et al., 2016).
The strengths of the current study are robust methodology, long-term intervention, and the use of standardized and validated assessment tools. Limitations of the study are possible confounding effects of the COVID-19 pandemic, nonsupervised sessions for the last 8 weeks, lack of objective assessments for QOL, and infeasibility of the blinding of participants.
Future studies should examine the effect of yogic practices on QOL in computer professionals suffering from CLBP, with objective assessment tools, fully supervised sessions and longer follow-up. Further, much robust research in this area through large multi-centric trial is warranted.
| Conclusion|| |
Yoga with mindfulness meditation and PE both demonstrated beneficial effects on psychological and physical aspects in computer users with CLBP. However, yoga with mindfulness meditation was more effective in improving the QOL in computer users with CLBP as compared to PE.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]