Yoga may help patients with MS

DALLAS ― A yoga program designed specifically for patients with multiple sclerosis (MS) improves walking ability, balance, fatigue, and general health status, and might even help control inflammation, a new pilot study suggests.

The results add weight to the importance of physical activity in MS patients, said lead study author Evan T. Cohen, PhD, a physical therapist and associate professor, Rutgers School of Health Related Professions, the State University of New Jersey, Stratford.

“Neurologists should be recommending exercise to their MS patients, and if a patient chooses yoga, that’s a viable option, depending on that person’s needs.”

However, it’s not possible from this study to say definitively that yoga is better than other modes of physical activity. Dr. Cohen pointed out that the study was “exploratory” and involved researchers “casting a very wide net.” Larger studies, now being planned, will likely bring in more conclusive information, he said.

Dr. Cohen presented the current study results at the 6th Cooperative Meeting of the Consortium of Multiple Sclerosis Centers (CMSC) and the Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS).

Expert Panel

The study enrolled 15 women, with a mean age of 53.5 years, who had been living with MS for about 14 years. They participated in specially designed yoga classes that were held at a nearby center. In a way, the size of the study was limited by the number of individuals who could fit into the yoga studio, commented Dr. Cohen.

The yoga program was developed by a panel of experts that included yoga instructors, researchers, patients who teach or practice yoga, healthcare providers, and scientists. Led by 2 trained teachers and an assistant, the classes were a “hybridized” version of various yoga styles, said Dr. Cohen. They included elements of breathing, meditation, yoga philosophy, relaxation, and yoga postures.

The program was specifically designed for MS patients with moderate disability, said Dr. Cohen. “It’s probably too easy for people in an early stage of the disease, but probably not appropriate for people in later stages.”

However, moderate disability can encompass varying levels of mobility. The study included patients with almost full function, as well as 2 patients whose primary mode of mobility was a wheelchair, even though they met the study’s inclusion criteria of being able to walk a certain distance, said Dr. Cohen.

The yoga program consisted of 2 90-minute sessions per week for 8 weeks.

Participants were encouraged to also practice yoga at home.

The classes were very well tolerated, with a participation rate of 89%. Fourteen of the 15 enrollees finished the program; 1 participant dropped out early. After complaining of chest pain while completing the 6-minute walk test, it was discovered that she had heart disease and needed surgery.

Researchers collected data at baseline (before the intervention), immediately after the intervention (at week 9), and again after an 8-week period (week 16).

They found significant improvements (P ˂ .05) at week 9 in the Timed 25 Walk Test (T25FW), the Nine-Hole Peg Test–Dominant Hand (NHPT-D), the 5-Times Sit-to-Stand (5STS) test, the Multidirectional Reach Test–Backward (MDRT-B), the 12-Item Multiple Sclerosis Walking Scale, the Modified Fatigue Impact Scale, the Mental Health Inventory (MHI), and several subscales of the 36- item Short Form Health Status Survey (SF-36). Significant improvements persisted to week 16 in performance of the T25FW, NHPT-D, 5STS, MDRT-B, and MHI.

One area of improvement was balance, noted Dr. Cohen. “In yoga, there is a lot of balancing on a stable platform ― you’re standing on your feet rather than moving around a lot like with Tai Chi exercises,” said Dr. Cohen.

Practice Element

How does yoga improve such deficits in MS? “I think that there’s an element of task-specific practice,” said Dr. Cohen. “In the posturing and the breathing, there may be an element of physical practice that might explain some of the changes in physical performance measures.”

As for improvements in quality-of-life measures, “an element of camaraderie and purpose” may be involved, said Dr. Cohen.

What sets this study apart from others is that the researchers took blood samples and are now analyzing the impact of yoga on various parameters. So far, said Dr. Cohen, preliminary analysis has shown changes to C-reactive protein and interleukin-6, -7, and -8, which, although interesting, is not conclusive.

But although changes in physical performance and quality-of-life measures may to some degree be attributable to a placebo effect, that cannot be the case for inflammatory markers. “You can’t lie about blood work,” said Dr Cohen, adding that these changes “certainly raise the question of what’s happening.”

Dr. Cohen cautioned, though, that the sample size was small.

The meditation element of yoga may have contributed in some way to improvements in quality of life, and perhaps even changes in blood work, said Dr. Cohen. “There’s evidence that shows that mindfulness and meditation have a physiological effect.”

The researchers now plan to do a larger study ― with as many as 60 participants to control for heterogeneity. That study would include some kind of control, possibly a “wait list” group, said Dr. Cohen.

Practicing yoga is common among MS patients. Surveys shows that between 12% and 31% of these patients have participated in yoga and that 60% to 80% found it helpful. However, although there is plenty of anecdotal evidence of yoga’s benefits, there has been little research to substantiate this, said Dr. Cohen.

Approached for a comment, Lily Jung-Henson, MD, a neurologist at Swedish Neuroscience Institute, Seattle, Washington, said the results “look great.”

“Although the sample size is small, there are essentially no negatives here regardless of whether the benefits we see are due to yoga itself or the socialization which it provides participants.”

Most neurologists and physiatrists already recommend yoga to their MS patients, said Dr. Jung-Henson. “This just gives us more incentive.”

Dr. Cohen reports no relevant financial relationships.

6th Cooperative Meeting of the Consortium of Multiple Sclerosis Centers (CMSC) and the Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS). Abstract SX02. Presented May 30, 2014.