|Year : 2021 | Volume
| Issue : 2 | Page : 109-115
Influence of Yoga-based program on health satisfaction in the Mongoloid patients diagnosed with type 2 diabetes mellitus
N Ibohal Singh1, Balaram Pradhan2, Mangesh Pandey1, Niranjan Parajuli3, Achouba Ksh Singh4
1 Division of yoga and Humanities, S-VYASA (Deemed-to-be University), Bengaluru, Karnataka, India
2 Division of Yoga and Humanities, S-VYASA (Deemed-to-be University), Bengaluru, Karnataka, India
3 Centre for Integrative Medicine and Research, AIIMS, New Delhi, India
4 Department of Endocrinology, Jawaharlal Nehru Institute of Medical Sciences, Imphal, Manipur, India
|Date of Submission||08-Oct-2021|
|Date of Decision||10-Nov-2021|
|Date of Acceptance||11-Nov-2021|
|Date of Web Publication||22-Dec-2021|
Division of Yoga and Humanities, S-VYASA (Deemed-to-be University), Bengaluru, Karnataka
Source of Support: None, Conflict of Interest: None
Background: Patients diagnosed with type 2 diabetes mellitus (T2DM) have to live with this condition throughout the life. Minimizing the complications and enhancing the overall health of patients with T2DM are the major global challenges. Improving the health satisfaction in diabetes patients can enhance their adherence to treatment and could minimize the complications of the disease.
Aim: The study evaluated the effects of Yoga along with treatment as usual on health satisfaction in T2DM patients of Mongoloid.
Methods: The design of the present study is randomized control trial. This study was approved by the institutional ethical committee of Jawaharlal Nehru Institute of Medical Sciences (JNIMS), Imphal, Manipur. Written informed consent was obtained from the participants before enrolling to the study. Four hundred and fifty diabetes patients belonging to Mongoloid race were screened for inclusion and exclusion criteria at the outpatient clinic of the Department of Endocrinology at JNIMS, Imphal, Manipur. Out of them, 310 participants (age range 25–80 years) were recruited for the study purpose for fulfilling the inclusion and exclusion criteria. Patients were randomized into Yoga along with treatment as usual group (N = 155) and treatment as usual group (N = 155). The Yoga along with treatment as usual group was prescribed oral antiglycemic agents and yoga intervention for 16 weeks. The treatment as usual group was prescribed oral antiglycemic agents only without any exercise during the period. Participants were assessed at baseline and at the end of the intervention by using the Current Health Satisfaction Questionnaire (CHES-Q). Final analysis included 151 participants in the Yoga along with treatment as usual group and 153 in the treatment as usual group. Four participants in the Yoga group and two participants in the control group were excluded from the study for discontinuing the treatment at the endocrinology department.
Results: Within-group analysis showed a significant improvement in all the subfactors of health satisfaction in both groups. There was a significant interaction (groups × times) in all domains of CHES-Q, except satisfied with the current level of energy, satisfied with current ability to sleep, satisfied with current blood sugar levels, and satisfied with current mood.
Conclusion: The findings of the present study showed improvement in health satisfaction in both groups. Results also indicated that Yoga along with treatment as usual is better compared to the control group. However, future studies considering clinical and anthropometric parameters along with health satisfaction are required to support the current findings.
Keywords: Current Health Satisfaction Questionnaire, health satisfaction, type 2 diabetes
|How to cite this article:|
Singh N I, Pradhan B, Pandey M, Parajuli N, Singh AK. Influence of Yoga-based program on health satisfaction in the Mongoloid patients diagnosed with type 2 diabetes mellitus. Yoga Mimamsa 2021;53:109-15
|How to cite this URL:|
Singh N I, Pradhan B, Pandey M, Parajuli N, Singh AK. Influence of Yoga-based program on health satisfaction in the Mongoloid patients diagnosed with type 2 diabetes mellitus. Yoga Mimamsa [serial online] 2021 [cited 2022 May 28];53:109-15. Available from: https://www.ym-kdham.in/text.asp?2021/53/2/109/333351
| Introduction|| |
Diabetes is a chronic disease or long-term medical condition characterized by an elevated level of blood glucose that adversely affects the health of individuals over time causing serious damage to the heart, blood vessels, eyes, and kidneys (WHO, n.d.). In 2014, around 422 million people aged above 18 years were diagnosed with diabetes. It was the direct cause of 1.5 million deaths in 2019 (WHO, 2021). In India, 65.1 million were living with diabetes in 2013 which is expected to increase to 1.09 million by 2035 (Khan et al., 2020). Type 1 diabetes, type 2 diabetes, and gestational diabetes are the major types of diabetes.
Type 2 diabetes (T2D), also called noninsulin dependent or adult onset, affects maximum numbers of individuals. 90% of people diagnosed with diabetes reported T2DM (Chatterjee, Khunti, & Davies, 2017). Prolonged T2DM leads to microvascular and macrovascular complication which causes significant psychological and physical complication (Chatterjee et al., 2017). Mental health problems such as depression, anxiety, and eating disorders are more common in patients with T2DM. Diabetes-related mental health comorbidities jeopardize treatment adherence, increasing the risk of major short- and long-term consequences such as blindness, amputations, stroke, cognitive decline, reduced quality of life, and premature death (Ducat, Philipson, & Anderson, 2014).
Patients diagnosed with T2DM have to live with this condition throughout their life. Minimizing the complications and enhancing the overall health of patients with T2DM are major global challenges. Improving the health satisfaction in diabetes patients can enhance their adherence to treatment and could minimize the complications of the disease. Health satisfaction is a unique concept which is defined as one's level of satisfaction, with various aspects of physical or mental health, such as body weight (BW), the current level of energy, or ability to interact socially with family and friends (Traina, Colwell, Crosby, & Mathias, 2015). Anomia, dissatisfaction, high body concern, poor environmental adaptability, low activity, and depression have all been linked to low health satisfaction (Kleiman, 1984). Patients with low health satisfaction preferred to die sooner in full health, while patients with high health satisfaction preferred to live longer in poor health (Dolan, Kavetsos, & Tsuchiya, 2013).
Yoga being a holistic science can enhance health satisfaction in patients diagnosed with T2DM. Yoga is a tradition of lifestyle, health, and spirituality. It balances and harmonizes the body, mind, and emotion (Liu et al., 2014). It consists of several mind–body practices including physical postures, breathing techniques, cleansing techniques, meditations, dietary changes, devotional sessions, and relaxation (Bhanu, Shankar, & Kutty, 2016). Scientific studies suggest that Yoga practice significantly improves several parameters in T2DM management, including glycemic control, lipid levels, and other anthropometric characteristics (Innes & Selfe, 2016; Miller, Kristeller, Headings, Nagaraja, & Miser, 2012; Shantakumari, Sequeira, & El Deeb, 2013). Yoga is also reported to minimize the diabetes-related risk profile such as lipid profile, blood pressure, and oxidative stress. It may also prevent and manage cardiovascular complication that arises due to T2DM (Innes & Vincent, 2007). Research also reported that Yoga minimizes anxiety, depression, and insomnia as well as enhances the quality of life in T2DM patients (Schmid et al., 2018; Shiju, Thomas, Al Arouj, Sharma, Tuomilehto, & Bennakhi, 2019) To the best of our knowledge, there is no study to assess the effect of Yoga on the health satisfaction of T2DM. Therefore, the present study is designed to assess the effect of Yoga-based program on the health satisfaction of the Mongoloid patients with T2DM.
| Materials and Methods|| |
The design of the current study is a randomized control trial (RCT). This study was approved by the institutional ethical committee of Jawaharlal Nehru Institute of Medical Sciences (JNIMS), Imphal, Manipur. Written informed consent was obtained from the participants before enrolling in the study.
Four hundred and fifty diabetes patients belonging to Mongoloid race were screened for inclusion and exclusion criteria at the outpatient clinic of the Department of Endocrinology at JNIMS, Imphal, Manipur (Institutional Registration Number Ac/02/IEC/JNIMS/2016/R). 310 participants were recruited for the study purpose for fulfilling the inclusion and exclusion criteria. Inclusion criteria were as follows: individuals diagnosed with T2DM (fasting blood glucose >120 mg%) for 1–15 years, male and female patients in the age range of 25–85 years, no previous exposure to physical exercise or Yoga practice, and willing to participate. The exclusion criteria are participants diagnosed with T2DM for more than 15 years, amputation of limbs, severe neuropsychiatric problems, and major complications associated with diabetes such as renal failure, history of coronary or cerebrovascular complications, and proliferative and patients with severe obesity (body mass index [BMI] >40). Participants were randomly allocated into two groups, namely Yoga along with treatment as usual/experimental group (N = 155) and treatment as usual/control group (N = 155) in a 1:1 ratio based on the lottery method. The sample size of the study was calculated using G*Power 3.1 (Erdfelder, Faul, Buchner, & Lang, 2009) with alpha 0.05 and power at 0.80 for an effect size of 0.3 of PPBS based on the earlier study (McDermott et al., 2014). Calculated sample size is 147 for each.
It is not possible to blind yoga interventional study. Nonetheless, the senior doctor of the Endocrinology Department of JNIMS and the senior yoga therapist/yoga teachers including the research supervisor and researcher were blinded during the process of randomization.
Yoga along with treatment as usual group was given oral antiglycemic agents and Yoga for 1½ h daily for 6 days a week for 16 weeks. The Yoga intervention for the experimental group was categorized into two parts, viz., (i) education on Yoga and spirituality through lecture classes and (ii) Yoga practice comprising asana, pranayama, kriya, meditation, and relaxation. 80 lecture classes on Yoga and spirituality were conducted during the intervention period. Likewise, 80 sessions on asana, 32 sessions on kriya, 48 sessions on pranayama, 48 sessions on meditation, and 96 sessions on relaxation were conducted in 16-week period. The detail of the Yoga module followed in the present study is shown in [Table 1]. The treatment as usual group was prescribed prescribed oral antiglycemic agents alone.
|Table 1: Common protocol for yoga intervention to type 2 diabetes mellitus patient|
Click here to view
The outcome measure of this study was health satisfaction. Health satisfaction was assessed using the Current Health Satisfaction Questionnaire (CHES-Q). CHES-Q (Traina et al., 2015) was administered at the baseline and postintervention. CHES-Q is a valid and reliable tool to assess the health satisfaction of diabetes patients with moderate internal reliability (Cronbach's alpha = 0.621) and acceptable test–retest reliability (Cronbach's alpha ≥0.70) (Traina et al., 2015). The CHES-Q has 14 items with 11 items focusing on satisfaction with weight, energy, appetite, sleep, physical functioning, social interactions, attitude, mood, blood sugar levels, blood pressure, and current health, as well as three items assessing knowledge of current blood sugar levels, blood pressure levels, and diabetes. Each item is rated with a 7-point Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree).
All statistical analysis was computed using JASP, Jeffrey's Amazing Statistics Program (official webpage: https://jasp-stats.org/), version 0.12.2, which is an open-source, free statistical software package. The cut-off value (alpha) was set at 0.05 level. Repeated measured analysis of variance (RM-ANOVA) was used to compare differences between the groups (Yoga and control) and within groups (pre and post). RM-ANOVA has a within-group factor (times) with two labels (pre and post) and a between-group factor (groups).
| Results|| |
Final analysis included 151 participants in the Yoga along with treatment as usual group and 153 in treatment as usual group. Four participants in the yoga group and two participants in the control group were excluded from the study for discontinuing the treatment at the endocrinology department.
Statistical analysis showed a significant improvement in all the subfactors of health satisfaction in both groups [Table 2]. Statistical analysis also showed a significant interaction (group × time) in the scores of satisfaction with current body weight [F (1, 302) = 19.43, p < 0.001, η2 = 0.06], satisfaction with current appetite [F (1, 302) = 32.33, p < 0.001, η2 = 0.10], Satisfied with current ability to sleep [F (1, 302) = 1.20, p < 0.001, η2 = 0.003], Satisfied with ability to do physical activities [F (1, 302) = 85.25, p < 0.001, η2 = 0.22], satisfaction with current ability to have social interaction [F (1, 302) = 26.90, p < 0.001, η2 = 0.08], satisfaction with current attitude to diabetes [F (1,302) = 15.79, p < 0.001, η2 = 0.05], and satisfaction with current mood [F (1, 302) = 0.05, p < 0.001, η2 = 0.00002], knowledge of current blood sugar [F (1, 302) = 20.79 p < 0.001, η2 = 0.06] and satisfaction with current blood sugar [F (1, 302) = 0.52, p < 0.001, η2 = 0.002], current knowledge of blood pressure, satisfaction with current health [F (1, 302)= 66.27, p < 0.001, η2 = 0.18] and Satisfied with current level of knowledge about diabetes [F (1,302) = 115.44, p < 0.001, η2 = 0.28].
|Table 2: Pre- and post-results of current health satisfaction of type 2 diabetes mellitus patients of the experimental of the Yoga intervention group and control group|
Click here to view
| Discussion|| |
The present study showed that Yoga along with treatment as usual and treatment as usual alone enhance all domains of health satisfaction. However, the effect of Yoga along with treatment as usual has a greater effect over treatment as usual alone.
To the best of our knowledge, this is the first study to assess the effects of Yoga along with treatment as usual on health satisfaction in patients with T2DM. This study is not directly comparable to the previous study. However, previous studies showed that Yoga significantly improves the quality of life and reduces the depression symptoms and intensity of depression symptoms in patients with diabetes (Satish & Lakshmi, 2016; Shiju et al., 2019).
The exact mechanism behind the improvement in health satisfaction in type 2 diabetes patients after Yoga along with treatment as usual intervention is not known clearly. Nevertheless, the enhancement in health satisfaction in type 2 diabetes patients can be associated with a reduction in fasting blood glucose, postprandial blood glucose, hemoglobin A1c, blood pressure, and lipid profile after Yoga intervention (Cui et al., 2017; Thind et al., 2017). This can improve the satisfaction toward current blood glucose, blood pressure, and current health. Yoga also reduces the weight, waist circumference, and BMI as well as improves the sleep quality in diabetes patients that can enhance the satisfaction toward current BW and current ability to sleep (Ebrahimi, Guilan-Nejad, & Pordanjani, 2017; McDermott et al., 2014). Yoga is reported to improve self-care, quality of life, and emotional distress in diabetes patients, which can also lead to better health satisfaction (Bock et al., 2019).
Likewise, all domains of health satisfaction were even significantly improved in the control group. Oral hypoglycemic agent reduces the fasting and postprandial sugar significantly (Luna & Feinglos, 2001). Reduction in glucose level normal or close to normal reduces the symptoms of type 2 diabetes. Moreover, improvement in the symptoms such as increased thirst, frequent urination, hunger, and fatigue can enhance health satisfaction in patients with diabetes.
Strength of the present study
As per our knowledge, this is the first study to assess the effects of Yoga along with treatment as usual on health satisfaction in type 2 diabetes patients. Research design (RCT) and large sample size are the major strengths of the current study. This study showed that Yoga along with treatment as usual is better than treatment as usual in improving the health satisfaction in patients with type 2 diabetes. Enhancement in health satisfaction may lead to better adherence to treatment and minimize the complication of diabetes.
Limitation of the present study
This study has not considered the clinical parameters such as fasting and postprandial blood glucose, glycosylated hemoglobin, as well as anthropometric parameters such as BW, BMI, systolic blood pressure, diastolic blood pressure, and pulse rate. Consideration of these parameters could better explain the current findings.
| Conclusion|| |
The findings of the present study showed improvement in health satisfaction in both groups. Results also indicated that Yoga along with treatment as usual is better compared to the control group. However, future studies considering clinical and anthropometric parameters along with health satisfaction are required to support the current findings.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Bhanu, R., Shankar, V. M., & Kutty, K. (2016). Influence of short term integrated approach of yoga therapy on quality of living in patients with type II diabetes mellitus. Indian Journal of Clinical Anatomy and Physiology
(2), 113. doi: 10.5958/2394-2126.2016.00027.x.
Bock, B. C., Thind, H., Fava, J. L., Dunsiger, S., Guthrie, K. M., Stroud, L., … & Wu, W. (2019). Feasibility of yoga as a complementary therapy for patients with type 2 diabetes: The Healthy Active and in Control (HA1C) study. Complementary Therapies in Medicine
, 125-131. doi: 10.1016/j.ctim.2018.09.019.
Chatterjee, S., Khunti, K., & Davies, M. J. (2017). Type 2 diabetes. The Lancet
(10085), 2239-2251. doi: 10.1016/S0140-6736(17)30058-2.
Cui, J., Yan, J. H., Yan, L. M., Pan, L., Le, J. J., & Guo, Y. Z. (2017). Effects of yoga in adults with type 2 diabetes mellitus: A meta-analysis. Journal of Diabetes Investigation
(2), 201-209. doi: 10.1111/jdi.12548.
Dolan, P., Kavetsos, G., & Tsuchiya, A. (2013). Sick but satisfied: The impact of life and health satisfaction on choice between health scenarios. Journal of Health Economics
(4), 708-714. doi: 10.1016/j.jhealeco.2013.04.002.
Ducat, L., Philipson, L. H., & Anderson, B. J. (2014). The mental health comorbidities of diabetes. JAMA
(7), 691. doi: 10.1001/jama.2014.8040.
Ebrahimi, M., Guilan-Nejad, T. N., & Pordanjani, A. F. (2017). Effect of yoga and aerobics exercise on sleep quality in women with type 2 diabetes: A randomized controlled trial. Sleep Science (Sao Paulo, Brazil)
(2), 68-72. doi: 10.5935/1984-0063.20170012.
Erdfelder, E., FAul, F., Buchner, A., & Lang, A. G. (2009). Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses. Behavior Research Methods
, 1149-1160. https://doi.org/10.3758/BRM.41.4.1149
Innes, K. E., & Selfe, T. K. (2016). Yoga for adults with type 2 diabetes: A systematic review of controlled trials. Journal of Diabetes Research
6979370. doi: 10.1155/2016/6979370.
Innes, K. E., & Vincent, H. K. (2007). The influence of yoga-based programs on risk profiles in adults with type 2 diabetes mellitus: A systematic review. Evidence Based Complementary and Alternative Medicine ECAM
, 469-486. doi: 10.1093/ecam/nel103.
Khan, M. A. B., Hashim, M. J., King, J. K., Govender, R. D., Mustafa, H., & Al Kaabi, J. (2020). Epidemiology of Type 2 Diabetes - Global Burden of Disease and Forecasted Trends. Journal of Epidemiology and Global Health
, 10(1), 107–111.doi: 10.2991/ jegh.k.191028.001.
Kleiman, M. B. (1984). Recent U.S. trends in the age decrement in health satisfaction: Preliminary findings. International Journal of Social Psychiatry
(3), 213-217. doi: 10.1177/002076408403000306.
Liu, X. C., Pan, L., Hu, Q., Dong, W. P., Yan, J. H., & Dong, L. (2014). Effects of yoga training in patients with chronic obstructive pulmonary disease: A systematic review and meta-analysis. Journal of Thoracic Disease
(6), 795-802. doi: 10.3978/j.issn.2072-1439.2014.06.05.
Luna, B., & Feinglos, M. N. (2001). Oral agents in the management of type 2 diabetes mellitus. American Family Physician
McDermott, K. A., Rao, M. R., Nagarathna, R., Murphy, E. J., Burke, A., Nagendra, R. H., … & Hecht, F. M. (2014). A yoga intervention for type 2 diabetes risk reduction: A pilot randomized controlled trial. BMC Complementary and Alternative Medicine
, 212. doi: 10.1186/1472-6882-14-212.
Miller, C. K., Kristeller, J. L., Headings, A., Nagaraja, H., & Miser, W. F. (2012). Comparative effectiveness of a mindful eating intervention to a diabetes self-management intervention among adults with type 2 diabetes: A pilot study. Journal of the Academy of Nutrition and Dietetics
(11), 1835-1842. doi: 10.1016/j.jand.2012.07.036.
Satish, L., & Lakshmi, V. S. (2016). Impact of individualized yoga therapy on perceived quality of life performance on cognitive tasks and depression among type II diabetic patients. International Journal of Yoga
(2), 130-136. doi: 10.4103/0973-6131.183707.
Schmid, A. A., Atler, K. E., Malcolm, M. P., Grimm, L. A., Klinedinst, T. C., Marchant, D. R., … & Portz, J. D. (2018). Yoga improves quality of life and fall risk-factors in a sample of people with chronic pain and type 2 diabetes. Complementary Therapies in Clinical Practice
, 369-373. doi: 10.1016/j.ctcp.2018.01.003.
Shantakumari, N., Sequeira, S., & El Deeb, R. (2013). Effects of a yoga intervention on lipid profiles of diabetes patients with dyslipidemia. Indian Heart Journal
(2), 127-131. doi: 10.1016/j.ihj.2013.02.010.
Shiju, R., Thomas, D., Al Arouj, M., Sharma, P., Tuomilehto, J., & Bennakhi, A. (2019). Effect of Sudarshan Kriya yoga on anxiety, depression, and quality of life in people with type 2 diabetes: A pilot study in Kuwait. Diabetes & Metabolic Syndrome: Clinical Research & Reviews
(3), 1995-1999. doi: 10.1016/j.dsx.2019.04.038.
Thind, H., Lantini, R., Balletto, B. L., Donahue, M. L., Salmoirago-Blotcher, E., Bock, B. C., … & Scott-Sheldon, L. A. (2017). The effects of yoga among adults with type 2 diabetes: A systematic review and meta-analysis. Preventive Medicine, 105
, 116-126. doi: 10.1016/j.ypmed.2017.08.017.
Traina, S. B., Colwell, H. H., Crosby, R. D., & Mathias, S. D. (2015). Pragmatic measurement of health satisfaction in people with type 2 diabetes mellitus using the Current Health Satisfaction Questionnaire. Patient Related Outcome Measures
, 103-115. doi: 10.2147/prom.s79368.
[Table 1], [Table 2]