Yoga Has Durable Benefits in Ulcerative Colitis

By Megan Brooks

November 04, 2016

NEW YORK (Reuters Health) - Patients with ulcerative colitis who practiced hatha yoga for 12 weeks experienced reductions in disease activity and improved quality of life and mental health in a randomized controlled trial, and the effects persisted for at least three months after the end of the intervention.

Reporting their findings in a poster at United European Gastroenterology (UEG) Week in Vienna, Dr. Jost Langhorst of the University of Duisburg-Essen, Germany, and colleagues say yoga can be discussed as a "safe, acceptable, and effective ancillary intervention for patients with ulcerative colitis and impaired quality of life."

Dr. A. Rani Elwy of Boston University School of Public Health in Massachusetts, who wasn't involved in the study, agrees. "If I were a GI doctor, I would very much consider recommending a course of yoga to my patients, to address some of the lower quality of life, increased anxiety and depression and perceived stress that they may be experiencing as a result of their colitis."

"This study shows once again that there is very little negative impact of offering yoga to patients, and the results usually far outweigh the expectations," Dr. Elwy told Reuters Health by email.

Dr. Langhorst and colleagues studied 77 patients with UC in clinical remission but with impaired quality of life (Inflammatory Bowel Disease Questionnaire, IBDQ<170). Their mean age was 45 and 75% were women. By random assignment, 39 participated in 90-minute sessions of traditional hatha yoga once a week and 38 were given written self-care lifestyle advice. Outcomes were assessed at weeks 12 and 24 by blinded evaluators.

After 12 weeks, compared to the control group, the yoga group showed significant improvements in disease-specific quality of life, physical quality of life, anxiety, depression and self-efficacy. These benefits were maintained at 24 weeks.

Additionally at 24 weeks, significant group differences favoring yoga were found for disease activity, mental quality of life, positive affect and perceived stress. In the yoga group, disease activity assessed by the clinical activity index dropped from 2.5 at baseline to 2.4 at week 12 to 1.7 at week 24, but increased from 2.0 to 2.6 to 2.8, respectively, in the control group (p=0.029), the authors report.

Dr. Dana J. Lukin, director of the Einstein-Montefiore Program for Inflammatory Bowel Diseases, who also wasn't involved in the study, told Reuters Health, "Yoga is a healthy physical activity, which is safe and compatible with use in UC and is a potentially useful adjunct to medical therapy in UC."

"Yoga is based on relaxation techniques and has a calming effect on the mind and body. Psychological stress and psychosocial variables play a key role in the subjective activity of inflammatory bowel disease. Patients suffering with UC frequently describe disease flares occurring during times of increased stress and that relaxation techniques are a key part of keeping their disease at bay. By taking dedicated time to focus on mind and body relaxation, yoga may help alleviate physical and emotional stress in a systematic manner," he explained in an email.

The German study, Dr. Lukin said, is "novel and should be commended for using several tools to assess subjective disease activity . . . in addition to objective laboratory indicators, such as fecal calprotectin, lactoferrin, and elastase. The results show small, but statistically significant improvements in the clinical activity index (CAI), mental quality of life, positive affect, perceived stress, and self-efficacy at 24 weeks in UC patients participating in weekly yoga for 12 weeks."

"However, it should be noted that there was no difference in laboratory or fecal biomarkers in this study. As such, the study is successful in demonstrating that yoga is associated with improved quality of life in UC patients but that it does not alter the underlying inflammatory process which is central to the disease. Therefore, the results must be interpreted with caution, as this technique has potential to complement medical therapy in improving quality of life in UC but should not be used as an alternative to medication use," Dr. Lukin said.

Dr. Elwy called for more research. "I would like to see a study like this replicated with more men, and with greater numbers and longer follow-up. It would also be a good next step to compare a yoga intervention to another, more active intervention that does not include yoga but is more active than writing," she said.

The study had no commercial funding and the authors have no relevant disclosures.