Yoga interventions and randomized controlled trials: key issues and the centered impact on sedentary lifestyle-associated cardiometabolic disorders

Figures

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  Figure 1. Graphical abstraction of sedentary lifestyle, associated risk factors, and the perspectives of meta-analysis.

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  Figure 2. Multidimensional overview of research trends, depicting yoga-based intervention strategies in the management of cardiometabolic-associated non-communicable diseases. (A) Rain-cloud plot of the keyword occurrence map, showing the strategies in the included studies. The size and clustering of key terms indicate the frequency and interrelationships among them, emphasizing the role of yoga interventions in cardiometabolic outcomes. (B) Sankey diagram representing the flow of evidence, NCD condition, yoga modalities, control conditions, and outcome domains in the included studies. (C) Temporal trend of publications from 2000 related to yoga, diabetes, and cardiovascular diseases in India. The upward trajectory illustrates the progressive increase in research output over time and scientific interest in including yoga as a complementary intervention for managing complications in NCD populations.

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  Figure 3. Database search and selection of studies according to the PRISMA 2020 guidelines. The flowchart depicts the process undertaken for the present meta-analysis review based on the systematic inclusion and exclusion strategy.

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  Figure 4. Overview of the risk of bias assessment of the studies selected for the meta-analysis. In the weighted bar plot, a percentage-wise summary of the risk of bias was systematically evaluated and reported. Green, red, and yellow bars correspond to low, high, and unclear risk of bias, respectively.

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  Figure 5. Forest plots of the effects of yoga interventions on hypertension, a factor related to a sedentary lifestyle. Data plots represented mean differences (MD) with 95% confidence intervals (CI) and were pooled using an inverse-variance random-effects model. (A) Diastolic blood pressure, a total of eight studies were included (yoga group n = 286; control group n = 358). A significant reduction in DBP with MD = −10.39 mmHg (95% CI −16.34 to −4.44), assessed using a two-sided Z-test, Z = 3.42, exact p = 0.0006, was noted, indicating outcomes favoring yoga intervention. (B) Systolic blood pressure included eight studies (yoga group n = 286; control group n = 306). The plot demonstrated a significant reduction in SBP favoring yoga intervention with MD = −5.67 mmHg, 95% CI −9.19 to −2.14; two-sided Z-test, Z = 3.15, p = 0.0020.

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  Figure 6. Forest plots of the effects of yoga on factors associated with type II diabetes and diseases related to a sedentary lifestyle. (A) Fasting blood glucose. Eleven studies were included in the meta-analysis, comprising a yoga group n = 697 and a control group n = 690. The plot shows a significant reduction in FBG favoring yoga intervention with MD = −12.25, 95% CI −21.30 to −3.19; two-sided Z-test, Z = 2.65, p = 0.008. (B) Postprandial blood sugar with eight included studies yoga group n = 628, and control group n = 615. The plot demonstrates a significant reduction in PPBS favoring yoga intervention with MD = −15.04, 95% CI −23.04 to −7.05; two-sided Z-test, Z = 3.69, p = 0.0002).

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  Figure 7. Forest plots of the effects of yoga on risk factors associated with cardiovascular diseases and diseases rooted in sedentary lifestyles. (A) Total cholesterol, eight studies were included for analysis comprising of yoga group n = 482 and the control group n = 481. The statistical analysis showed a significant reduction in TC favoring yoga intervention with calculated MD = −15.04, 95% CI −27.48 to −2.61; two-sided Z-test, Z = 2.37, p = 0.020). (B) Low-density lipoprotein. Five studies were included with yoga group n = 388 and control group n = 384. The pooled effect was not statistically significant (MD = −9.09, 95% CI −18.67 to 0.48; two-sided Z-test, Z = 1.86, p = 0.060). The MD is −9.09, 95% CI −18.67 to 0.48; two-sided Z-test, Z = 1.86, p = 0.060, which was not statistically significant.

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  Figure 8. Subgroup analysis of blood pressure outcomes. (A) DBP based on intervention type; (B) DBP based on duration; (C) SBP based on intervention type; (D) SBP based on duration. Subgroups were defined by general/integrated yoga vs pranayama-based interventions and duration (≤3 months vs >3 months. Effect sizes are expressed as standardized mean differences (SMD) with 95% confidence intervals using a random-effects model.

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  Figure 9. Subgroup analysis of glycemic outcome measures. (A) Effect on FBG based on intervention type; (B) Effect on FBG based on duration of intervention; (C) PPBS based on yoga intervention; (D) PPBS based on duration. Subgroups were defined general/integrated yoga vs pranayama-based interventions and duration (≤8 weeks vs >8 weeks). Effect sizes are expressed as standardized mean differences (SMD) with 95% confidence intervals using a random-effects model.

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  Figure 10. Subgroup analysis of lipid profiles as cardiometabolic outcomes. (A) TC based on intervention type; (B) TC based on duration; (C) LDL based on intervention type; (D) LDL based on duration Subgroups were defined as general/integrated yoga vs pranayama-based interventions and duration (≤8 weeks vs >8 weeks). Effect sizes are expressed as SMD with 95% confidence intervals using a random-effects model.