Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 54  |  Issue : 2  |  Page : 70-77

Intensive integrated yoga therapy on lipid profile, body composition, and insulin resistance among Type 2 diabetes mellitus


1 Department of Integrative Medicine, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, Karnataka, India
2 Department of Molecular Bioscience, Swami Vivekananda Yoga Anusandhana Samsthana, Bengaluru, Karnataka, India
3 Lal Path Lab, Mumbai, Maharashtra, India

Date of Submission01-Aug-2022
Date of Decision10-Oct-2022
Date of Acceptance04-Nov-2022
Date of Web Publication15-Dec-2022

Correspondence Address:
Dr. Jintu Kurian
Swami Vivekananda Yoga Anusandhana Samsthana, Anekal Taluk, Kallubalu Post, Vivekananda Road, Jigani, Bengaluru - 560 105, Karnataka
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ym.ym_108_22

Rights and Permissions
  Abstract 


Background: Insulin resistance (IR) is a leading cause of the onset of Type 2 diabetes mellitus (T2DM) among overweight and obese individuals irrespective of their age. This study aimed at assessing the impact of 2 weeks of intensive integrated yoga therapy (IIYT) among overweight individuals diagnosed with T2DM identified with higher IR.
Methodology: The current single-group longitudinal pre–post study enrolled adults (n = 30) from a residential health-care center, Bengaluru (India), who were subjected to IIYT, comprising practices at physical, emotional, and intellectual levels incorporating āsana (postures), prāṇāyāma (breathing exercise), kriyā (internal cleansing technique), meditation, notional correction, counseling, yogic diet, and devotional sessions. Pre- and postoutcome measures were homeostatic model assessment for IR (HOMA-IR), fasting serum insulin, lipid profile, body composition, and anthropometric measurements.
Results: A significant reduction in HOMA-IR (35.69%, p < 0.001), fasting insulin (28%, p < 0.001), fasting glucose (12.3%, p = 0.039), triglycerides (15.43%, p = 0.003), very low-density lipoprotein (15.5%, p = 0.003), body mass index (2.4%, p < 0.001), weight (2.3%, p < 0.001), hip circumference (1.01%, p < 0.001), waist circumference (1.4%, p < 0.001), and body fat percentage (1.8%, p = 0.039) and a significant increase in lean mass percentage (0.95%, p = 0.045) and water percentage (0.99%, p = 0.04) were observed among the subjects.
Conclusion: Regular practice of IIYT regulates lipid and anthropometric measures and increases lean body mass, thereby managing IR, among overweight Type 2 diabetes. However, future works might confirm the findings of the present study.

Keywords: Body composition, insulin resistance, integrated intensive yoga therapy, Type 2 diabetes


How to cite this article:
Bilagi A, Kurian J, Bilagi S. Intensive integrated yoga therapy on lipid profile, body composition, and insulin resistance among Type 2 diabetes mellitus. Yoga Mimamsa 2022;54:70-7

How to cite this URL:
Bilagi A, Kurian J, Bilagi S. Intensive integrated yoga therapy on lipid profile, body composition, and insulin resistance among Type 2 diabetes mellitus. Yoga Mimamsa [serial online] 2022 [cited 2023 Feb 6];54:70-7. Available from: https://www.ym-kdham.in/text.asp?2022/54/2/70/363804




  Introduction Top


People with higher body weight are prone to insulin resistance (IR), resulting in the early onset of Type 2 diabetes mellitus (T2DM),[1] which encompasses a broad range of pathology proceeding to elevated mean arterial pressure, dyslipidemia,[2] abdominal obesity,[3] glucose intolerance,[4] and inflammations[5] resulting in higher risk for cerebrovascular disease.[6] Incidence for IR-induced T2DM is reportedly high among Asians,[7] and two of the postulated causes among many identified etiologies are excess body fat and abdominal obesity.[8]

As known, the pathogenesis of T2DM is related to glucose intolerance. Among individuals with normal glucose tolerance, the release of serum insulin from pancreatic β-cells in acute and sustained phases[9] is dependent on the quantity of ingested glucose, retaining the normal glucose tolerance.[10] Although, the way by which cells convert glucose to energy is associated with the secreted insulin from β-cells.[11] The resultant dynamic interaction between pancreatic insulin secretion and cellular insulin sensitivity is essential for normal glucose tolerance.[12] The inability of insulin to impart numerous actions in the cell in spite of impaired secretion from β-cell IR is seen much before hyperglycemia and the onset of associated metabolic abnormalities.[13] Apart from genetic markers that establish IR, several IR-related metabolic abnormalities can be aggravated by chronic overweight[14] in addition to physiological stress.[15]

According to published reports, T2DM is largely preventable and manageable through lifestyle modification,[16] involving diet,[17] exercise,[18] stress management,[19] and smoking cessation.[20] Lifestyle interventions are known to play an effective role than medications,[21] so patients can access to nonpharmacological interventions[22] such as physical activities,[23] diet modification,[24] and complementary and alternative medicine (CAM).[25] Yoga as a CAM[26] is found with enormous benefits in addressing IR among people with diabetes.[27] Hence, this study used an integrated approach of yoga comprising physical postures, breathing techniques, and meditation as an intervention in addressing IR and related factors such as body composition, anthropometric measures, and lipid profile, thereby managing T2DM. Studies focusing on IR in T2DM after a module of intensive integrated yoga therapy (IIYT) are lacking. Therefore, the present study was designed with a hypothesis that IIYT can reduce IR within a short span of 2 weeks among patients with T2DM.


  Methodology Top


Subjects

All patients admitted to the diabetes wing of Arogyadhama, a residential integrative holistic health center based in Bengaluru (India), fitting into the inclusion criteria were recruited after screening by medical history, physical examination, and laboratory tests. Signed informed consent was sought before the assessments, and the study criteria included patients with T2DM of both genders in age range from 35 to 75 years, without any major complications such as unstable angina, proliferative retinopathy, and severe peripheral vascular disease. Those who practiced yoga regularly over the previous 3-month period were excluded.

Design

This was a single-group pre–post design, and all patients underwent 2 weeks of residential IIYT [Figure 1] by certified yoga therapists under the guidance of the chief yoga therapy consultant from a deemed-to-be-yoga university, Bengaluru. IIYT included special diet, physical postures (āsanā), breathing technique (prāṇāyāma), internal cleansing technique (kriyā), meditation, notional correction, and devotional sessions. Daily 2 physical posture sessions were conducted starting with yogic loosening practices (sukṣma vyāyāmas) and breathing exercises followed by easy postures gradually moving toward more dynamic ones. Maintenance in the final posture of āsanās was encouraged. The internal cleansing technique was practiced 2 days in a week on empty stomach in the morning. Lectures were conducted by a senior faculty at the yoga university, a dietician, and a clinician to explain the yogic concept of disease and health, modern biomedical understanding of diabetes, its pathophysiology, and modalities of management. All the patients had yogic counseling by psychologists trained in yoga, and the assessments were done on the 1st day before the intervention and on the 14th day. Daily vital parameters were monitored by the medical team of the health home.
Figure 1: Study flowchart

Click here to view


Assessments

Homeostasis model assessment of insulin resistance

This is an indirect method used to quantify IR[28] derived by the formula (fasting insulin [mU/L] × fasting glucose [mg/dL]/405). Blood glucose and insulin were estimated on the venous blood in a certified laboratory.

Biochemical parameters (fasting blood glucose, postprandial blood glucose, lipid profile, and fasting insulin)

Three milliliters of fasting (12 h) and 1 ml of postprandial (2 h after breakfast) blood samples were collected from venous puncture, and sent to laboratory for biochemical analysis. Serum insulin was estimated by solid-phase radioimmunoassay with an intra- and inter-assay coefficient of variation of 2.2%–6.1% and specificity of 4 ng/ml. Total cholesterol (intra-assay coefficient of variation CV 0.8%, inter-assay CV 1.7%), triglycerides (intra-assay CV 1.5%, inter-assay CV 1.8%), and glucose (intra-assay CV 0.9%, inter-assay CV 1.8%) were measured using the enzymatic calorimetric method. HDL cholesterol (intra-assay CV 2.9%, inter-assay CV 3.6%) was measured using a homogenous calorimetric assay, whereas LDL cholesterol (intra-assay CV 0.9%, inter-assay CV 2.0%) was measured using a homogenous turbid metric assay.

Body composition

This measurement included body fat, lean body mass, and water percentage obtained by the body-fat analyzer (BF 905, Maltron, UK).[29] The recording was done using the standard method after the patient rested comfortably in a supine position with their legs and arms slightly apart. Four electrodes were applied on the right side of the body on the hand, wrist, foot, and ankle with a total duration of 5 min.

Anthropometric measurements

Body weight: This was measured with the patient wearing light clothes on a research grade (DI 20, Essae, India) electronic weighing scale (nearest error of 0.1 kg). Height: Standing height was measured using wall mounted stadiometer with a nearest of 0.1 cm. Waist circumference: The horizontal girth at the midpoint between costal margin and iliac crests was measured with nonstretchable centimeter tape. Hip circumference: greatest horizontal circumference at the level of greater trochanters was measured using the same measuring tape.

Intervention

An integrated yoga therapy module [Table 1] was developed by a team consisting of a diabetologist, pathologist, physician, yoga therapist, and a philosopher with in-depth knowledge and experience of yoga. An integrated yoga program combines practices intended to act at physical, emotional, intellectual, and spiritual levels and includes diet, āsanās, prāṇāyāma, kriyā, meditation, notional correction, and devotional sessions.[30] This yoga module was derived from principles of ancient texts (Patanjali Yoga Sutras and Taittiriya Upanishad) and of traditional medicine involving a holistic healing approach.[31]
Table 1: Yoga module

Click here to view


Ethics

This study was presented in the Research Departmental meeting and got approved by the Institutional Ethical Committee (RES/IEC-SVYASA/74/2019). Signed informed consent detailing about the nature and need of the study was obtained from all the participants before data collection. Ethical part was followed like drawing the blood and coding of data. Participants were given the freedom to quit the study at any point indicating the reason.

Data analysis

Data were analyzed by a statistician using the Statistical Package for the Social Sciences (SPSS, IBM SPSS Statistics, Chicago, IL, USA) version 23.0. Kolmogorov–Smirnov's test was used to check the normality of baseline data. Two related samples Wilcoxon's signed-rank t-test was used to check for pre–post changes as the data were not normally distributed.


  Results Top


Among the identified subjects with T2DM (N=98), close to one-half of them (n=44, 44.9%) consented to take part in this study. Among them, the majority (n=36) of them, who fitted into the inclusion-exclusion criteria got enrolled. The recruited subjects were with T2DM for a duration of 10.93 ± 7.90 years (ranging from 1 to 28 years). And, majority of them (n=30, 56.57 ± 9.19 years ranging from 36 to 71 years) [Table 2] completed the study. Furthermore, a few of them dropped themselves out (n=5) of the study, citing reasons like family emergencies (n=2) and office-related problems (n=2). Whereas, due to insufficient blood serum, one of the subject's sample was eliminated from tests and analysis [Figure 1].
Table 2: Demographic data

Click here to view


Post-IIYT intervention and HOMA-IR showed a 35.7% reduction (p < 0.001) from mean ± standard deviation of 3.10 ± 1.57–1.89 ± 1.10 with an effect size of 0.71. The fasting insulin showed a 28% reduction (p < 0.001) with an effect size of 0.76. The fasting blood glucose (FBS) showed a 12.3% decrease (p = 0.039) with effect size of 0.3, whereas postprandial blood glucose showed a 12.3% decrease (p = 0.061) with an effect size of 0.32. Moreover, there was a significant reduction in triglycerides (p = 0.003) and very low-density lipoprotein (VLDL) (p = 0.003) [Table 3].
Table 3: Changes in biochemical and clinical variables after yoga

Click here to view


Parameters like body mass index (BMI) were found with a reduction of 2.36% (p < 0.001, effect size: 1.28), body weight by 2.3% (p < 0.001, effect size: 1.19), waist circumference by 1.36% (p < 0.001, effect size: 1.07), hip circumference by 1.01% (p < 0.001, effect size: 0.89), and body fat percentage by 1.81% (p = 0.039, effect size: 0.39), while parameters like lean mass percentage increased by 3.76% (p = 0.045, effect size: 0.37) and water percentage increased by 1% [p = 0.045, effect size: 0.38, [Table 4]].
Table 4: Body composition

Click here to view



  Discussion Top


This study resulted in manifesting positive impact of intensive integrated yoga practice for 2 weeks was effective in managing HOMA-IR, fasting insulin, FBS, triglycerides, VLDL, weight, BMI, hip/waist circumference, and body fat percentage with increased lean body mass among the patients, rejecting the null hypothesis. The study found a reduction by 2.3% in weight and 2.4% in BMI within 2 weeks of IIYT, which is in line with a previous report. For example, Telles et al.[32] reported a decrease by 1.6% in obese nondiabetic subjects in a residential interventional approach conducted for 6 days. Furthermore, Gram's study showed varying degrees of reduction in weight of approximately 10% among people with Type 2 diabetes with lifestyle intervention.[33]

However, an increase in weight by 1.2% noted by Malhotra et al.[42] was an unusual observation. Vaishali et al.[31] reported that yoga-based programs were associated with a 3.5%–8.2% reduction in body weight.[34] These differences may be attributed to several factors such as differences in design, lack of strict monitoring over the diet as most of them were outpatient studies, and/or the type of yoga module used.

It is known that body composition, which includes percentage of fat, lean mass, and total body water, is a simple measure that has a high correlation with blood glucose, HbA1c, and cholesterol.[35] Furthermore, visceral and central abdominal fat is strongly associated with impaired glucose tolerance, IR, and T2DM. This study showed a 1.36% decrease in waist circumference, which was lesser than that (3.89%) observed by Telles et al.,[32] among obese subjects in an inpatient yoga program daily in north India similar to our setup. It is interesting to note that the study reported a higher reduction in WC than our study, as the body fat percentage had increased by 1.66% while we observed a reduction in body fat by 1.8%. Our result is similar to Gastaldelli et al.'s study[36] that observed a reduction in body fat by 1%. An increase in lean body mass with a decrease in fat percentage and BMI[37] is the favorable change that indicates improved muscle mass and muscle/fat ratio,[38] and our study recorded a similar pattern. Earlier studies on yoga have documented a reduction in lean body mass: 10.9% by Malhotra et al.,[42] and 4.4% by Telles et al.,[32] in nondiabetic obese volunteers,[32] and the differences might have been attributed to the module of yoga practices and the diet provided during the experiment.

Our study found a significant reduction in HOMA IR by 35.7%, fasting insulin by 28%, and glucose by 12.3%. These values are much higher than that observed after metformin intake. which showed a reduction in IR by 26.8% when it was combined with a 6-month multidisciplinary lifestyle intervention among obese adolescents[39] or in physically inactive healthy subjects after moderate doses (500 mg/3 times/day) for 1 week that showed a reduction in IR by 25%.[40] Thus, it appears that IIYT is better than metformin alone or in combination with conventional multidisciplinary lifestyle modification. Our study is supported by earlier observations on IR using insulin clamp study,[41] which was a gold standard to measure IR, in healthy volunteers with long-term yoga practice (≥1 year) with significantly better insulin sensitivity than control group.

Malhotra et al.[42] reported the effect of yogāsanās with emphasis on maintenance in āsanās found a rise in plasma insulin levels unlike our and other studies and suggested that yogic postures (āsanās) may release stored insulin or free the bound insulin from the pancreas when abdomen pressure is applied and the study reported a significant reduction in fasting glucose by 12.3%, which coincides with our study and also a previous study by Amita et al.[43] These evidences proclaim the effects of yoga in reducing blood glucose levels ranging from 10% to 35% depending on the type and duration of the practices which is remarkable. This may pave the way to prepare structured recommendations for the use of different types of yoga in different stages of T2DM.

Mechanism

Exhibiting a significant decrease in IR, this study implies that IIYT has the potential to increase cell wall sensitivity to insulin and hence redress the basic T2DM pathology.[44] A previous study on yoga has shown a decrease in inflammatory responses to stressful encounters that influence the burden that stressors place on an individual.[45] Yoga has shown improvement in adiponectin level and metabolic syndrome risk in obese postmenopausal women.[46] Further, weight reduction by lifestyle intervention was associated with improvements in blood inflammatory markers in obese children and adolescents.[47] These facts point to the holistic approach of yoga as effective enough in correcting the problems at several levels to restore metabolic and glycemic homeostasis.[48]

IIYT is a lifestyle management program that includes various activities such as included yogic diet, āsanās, prāṇāyāma, relaxation techniques, kriyā, meditation, yogic counseling, devotional sessions for emotion culturing, and lectures. This module has proven effective to reduce stress in a previous study.[49] Similar observation is made in this study which could be due to improved pancreatic beta-cell function, skeletal muscle cell receptor's sensitivity to glucose signal through reduced IR. Furthermore, the reversibility model of yoga proposes that resting is needed to the body and mind to enhance mindfulness[50] that could lead to restoration of homeostasis by balancing the HPA axis and psychoneuroimmunological[51] and oxidative stress[52] pathways. This study provided evidence to the efficacy of intensive yoga in managing the two basic abnormalities among T2DM, which are IR and body composition within a short period of 2 weeks. Future RCTs on larger sample may be conducted including other variables such as cytokines and free radical assessments to understand the mechanism of such intensive yoga programs should be conducted to strengthen the findings. However, in addition to low sample size and short intervention period, one of the major limitations of this study is not having a control group and a weak design. Therefore, the authors of this study would suggest future studies to have stringer study designs like randomized control trials.


  Conclusion Top


This study on T2DM conducted among people with IR showed the potential role of IIYT on two basic abnormalities among T2DM, which are IR and body composition. Therefore, we postulate that IIYT can serve as a cost-effective complementary and alternative therapy for the management of T2DM and can help reduce the requirement of oral hypoglycemic agents or insulin by improving glucose tolerance.

Acknowledgment

The authors would like to thank the management of S-VYASA, the subjects who had taken part in this study, the staffs of Arogyadhama Health Care Home, Dr. Nagarathna and Professor Agoramurthy for the guidance, and Dr. Balaram Pradhan for the statistical help.

Financial support and sponsorship

This study was financially supported by Swami Vivekananda Yoga Anusandhana Samsthana S-VYASA Deemed-to-be-University, Jigani, Bengaluru, Karnataka.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Sung KC, Jeong WS, Wild SH, Byrne CD. Combined influence of insulin resistance, overweight/obesity, and fatty liver as risk factors for type 2 diabetes. Diabetes Care 2012;35:717-22.  Back to cited text no. 1
    
2.
Pöykkö SM, Kellokoski E, Hörkkö S, Kauma H, Kesäniemi YA, Ukkola O. Low plasma ghrelin is associated with insulin resistance, hypertension, and the prevalence of type 2 diabetes. Diabetes 2003;52:2546-53.  Back to cited text no. 2
    
3.
Miyazaki Y, Glass L, Triplitt C, Wajcberg E, Mandarino LJ, DeFronzo RA. Abdominal fat distribution and peripheral and hepatic insulin resistance in type 2 diabetes mellitus. Am J Physiol Endocrinol Metab 2002;283:E1135-43.  Back to cited text no. 3
    
4.
Prior JO, Quiñones MJ, Hernandez-Pampaloni M, Facta AD, Schindler TH, Sayre JW, et al. Coronary circulatory dysfunction in insulin resistance, impaired glucose tolerance, and type 2 diabetes mellitus. Circulation 2005;111:2291-8.  Back to cited text no. 4
    
5.
Greenfield JR, Campbell LV. Relationship between inflammation, insulin resistance and type 2 diabetes: 'Cause or effect'? Curr Diabetes Rev 2006;2:195-211.  Back to cited text no. 5
    
6.
Inzucchi SE, Viscoli CM, Young LH, Furie KL, Gorman M, Lovejoy AM, et al. Pioglitazone prevents diabetes in patients with insulin resistance and cerebrovascular disease. Diabetes Care 2016;39:1684-92.  Back to cited text no. 6
    
7.
Yajnik CS. Early life origins of insulin resistance and type 2 diabetes in India and other Asian countries. J Nutr 2004;134:205-10.  Back to cited text no. 7
    
8.
Isharwal S, Arya S, Misra A, Wasir JS, Pandey RM, Rastogi K, et al. Dietary nutrients and insulin resistance in Urban Asian Indian adolescents and young adults. Ann Nutr Metab 2008;52:145-51.  Back to cited text no. 8
    
9.
Del Prato S, Marchetti P, Bonadonna RC. Phasic insulin release and metabolic regulation in type 2 diabetes. Diabetes 2002;51 Suppl 1:S109-16.  Back to cited text no. 9
    
10.
Gannon MC, Nuttall FQ, Neil BJ, Westphal SA. The insulin and glucose responses to meals of glucose plus various proteins in type II diabetic subjects. Metabolism 1988;37:1081-8.  Back to cited text no. 10
    
11.
Li C, Chen P, Vaughan J, Lee KF, Vale W. Urocortin 3 regulates glucose-stimulated insulin secretion and energy homeostasis. Proc Natl Acad Sci U S A 2007;104:4206-11.  Back to cited text no. 11
    
12.
Tripathy D, Carlsson M, Almgren P, Isomaa B, Taskinen MR, Tuomi T, et al. Insulin secretion and insulin sensitivity in relation to glucose tolerance: Lessons from the Botnia Study. Diabetes 2000;49:975-80.  Back to cited text no. 12
    
13.
Ferrannini E. Is insulin resistance the cause of the metabolic syndrome? Ann Med 2006;38:42-51.  Back to cited text no. 13
    
14.
Gallagher EJ, LeRoith D, Karnieli E. The metabolic syndrome – From insulin resistance to obesity and diabetes. Endocrinol Metab Clin North Am 2008;37:559-79, vii.  Back to cited text no. 14
    
15.
Nolan CJ, Ruderman NB, Kahn SE, Pedersen O, Prentki M. Insulin resistance as a physiological defense against metabolic stress: Implications for the management of subsets of type 2 diabetes. Diabetes 2015;64:673-86.  Back to cited text no. 15
    
16.
Sanghani NB, Parchwani DN, Palandurkar KM, Shah AM, Dhanani JV. Impact of lifestyle modification on glycemic control in patients with type 2 diabetes mellitus. Indian J Endocrinol Metab 2013;17:1030-9.  Back to cited text no. 16
    
17.
Albarran NB, Ballesteros MN, Morales GG, Ortega MI. Dietary behavior and type 2 diabetes care. Patient Educ Couns 2006;61:191-9.  Back to cited text no. 17
    
18.
Kirwan JP, Sacks J, Nieuwoudt S. The essential role of exercise in the management of type 2 diabetes. Cleve Clin J Med 2017;84:S15-21.  Back to cited text no. 18
    
19.
Surwit RS, van Tilburg MA, Zucker N, McCaskill CC, Parekh P, Feinglos MN, et al. Stress management improves long-term glycemic control in type 2 diabetes. Diabetes Care 2002;25:30-4.  Back to cited text no. 19
    
20.
Eadington DW, Patrick AW, Frier BM. Association between connective tissue changes and smoking habit in type 2 diabetes and in non-diabetic humans. Diabetes Res Clin Pract 1991;11:121-5.  Back to cited text no. 20
    
21.
Sheng Z, Cao JY, Pang YC, Xu HC, Chen JW, Yuan JH, et al. Effects of lifestyle modification and anti-diabetic medicine on prediabetes progress: A systematic review and meta-analysis. Front Endocrinol (Lausanne) 2019;10:455.  Back to cited text no. 21
    
22.
Dyer AH, Briggs R, Mockler D, Gibney J, Kennelly SP. Non-pharmacological interventions for cognition in patients with type 2 diabetes mellitus: A systematic review. QJM 2020;113:155-61.  Back to cited text no. 22
    
23.
Sigal RJ, Kenny GP, Wasserman DH, Castaneda-Sceppa C, White RD. Physical activity/exercise and type 2 diabetes: A consensus statement from the American Diabetes Association. Diabetes Care 2006;29:1433-8.  Back to cited text no. 23
    
24.
Barnard ND, Cohen J, Jenkins DJ, Turner-McGrievy G, Gloede L, Green A, et al. A low-fat vegan diet and a conventional diabetes diet in the treatment of type 2 diabetes: A randomized, controlled, 74-wk clinical trial. Am J Clin Nutr 2009;89:1588S-96S.  Back to cited text no. 24
    
25.
Al-Eidi S, Tayel S, Al-Slail F, Qureshi NA, Sohaibani I, Khalil M, et al. Knowledge, attitude and practice of patients with type 2 diabetes mellitus towards complementary and alternative medicine. J Integr Med 2016;14:187-96.  Back to cited text no. 25
    
26.
Mangala Gowri M, Rajendran J, Srinivasan AR, Bhavanani AB, Meena R. Impact of an integrated yoga therapy protocol on insulin resistance and glycemic control in patients with type 2 diabetes mellitus. Rambam Maimonides Med J 2022;13:e0005.  Back to cited text no. 26
    
27.
Patil SG, Aithala MR, Naregal GV, Shanmukhe AG, Chopade SS. Effect of yoga on cardiac autonomic dysfunction and insulin resistance in non-diabetic offspring of type-2-diabetes parents: A randomized controlled study. Complement Ther Clin Pract 2019;34:288-93.  Back to cited text no. 27
    
28.
Turner RC, Levy JC, Rudenski AS, Hammersley M, Page R. Measurement of insulin resistance and beta-cell function: the HOMA and CIGMA approach. In Current topics in diabetes research. Karger Publishers 1993;12:66-75.  Back to cited text no. 28
    
29.
Singh RB, Niaz MA, Beegom R, Wander GS, Thakur AS, Rissam HS. Body fat percent by bioelectrical impedance analysis and risk of coronary artery disease among urban men with low rates of obesity: The Indian paradox. J Am Coll Nutr 1999;18:268-73.  Back to cited text no. 29
    
30.
Venkata Giri Kumar P, Deshpande S, Joshi A, More P, Nagendra HR. Significance of arterial stiffness in Tridosha analysis: A pilot study. J Ayurveda Integr Med 2017;8:252-6.  Back to cited text no. 30
    
31.
Vaishali K, Kumar KV, Adhikari P, UnniKrishnan B. Effects of yoga-based program on glycosylated hemoglobin level serum lipid profile in community dwelling elderly subjects with chronic type 2 diabetes mellitus – A randomized controlled trial. Phys Occup Ther Geriatr 2012;30:22-30.  Back to cited text no. 31
    
32.
Telles S, Naveen VK, Balkrishna A, Kumar S. Short term health impact of a yoga and diet change program on obesity. Med Sci Monit 2010;16:R35-40.  Back to cited text no. 32
    
33.
Grams J, Garvey WT. Weight loss and the prevention and treatment of type 2 diabetes using lifestyle therapy, pharmacotherapy, and bariatric surgery: Mechanisms of action. Curr Obes Rep 2015;4:287-302.  Back to cited text no. 33
    
34.
Nayak VK, Raghurama Nayak K, Vidyasagar S, Kamath A. Body composition analysis, anthropometric indices and lipid profile markers as predictors for prediabetes. PLoS One 2018;13:e0200775.  Back to cited text no. 34
    
35.
Hayashi T, Boyko EJ, Leonetti DL, McNeely MJ, Newell-Morris L, Kahn SE, et al. Visceral adiposity and the risk of impaired glucose tolerance: A prospective study among Japanese Americans. Diabetes Care 2003;26:650-5.  Back to cited text no. 35
    
36.
Gastaldelli A, Cusi K, Pettiti M, Hardies J, Miyazaki Y, Berria R, et al. Relationship between hepatic/visceral fat and hepatic insulin resistance in nondiabetic and type 2 diabetic subjects. Gastroenterology 2007;133:496-506.  Back to cited text no. 36
    
37.
Van Der Heijden GJ, Wang ZJ, Chu Z, Toffolo G, Manesso E, Sauer PJ, et al. Strength exercise improves muscle mass and hepatic insulin sensitivity in obese youth. Med Sci Sports Exerc 2010;42:1973-80.  Back to cited text no. 37
    
38.
Choi K, Kim YB. Molecular mechanism of insulin resistance in obesity and type 2 diabetes. Korean J Intern Med 2010;25:119-29.  Back to cited text no. 38
    
39.
Clarson CL, Mahmud FH, Baker JE, Clark HE, McKay WM, Schauteet VD, et al. Metformin in combination with structured lifestyle intervention improved body mass index in obese adolescents, but did not improve insulin resistance. Endocrine 2009;36:141-6.  Back to cited text no. 39
    
40.
Ou HY, Cheng JT, Yu EH, Wu TJ. Metformin increases insulin sensitivity and plasma beta-endorphin in human subjects. Horm Metab Res 2006;38:106-11.  Back to cited text no. 40
    
41.
Chaya MS, Ramakrishnan G, Shastry S, Kishore RP, Nagendra H, Nagarathna R, et al. Insulin sensitivity and cardiac autonomic function in young male practitioners of yoga. Natl Med J India 2008;21:217-21.  Back to cited text no. 41
    
42.
Malhotra V, Singh S, Sharma SB, Gupta P, Prasad A, Tandon OP, et al. The status of NIDDM patients after yoga asanas: Assessment of important parameters. J Clin Diagn Res 2010;4:2652-67.  Back to cited text no. 42
    
43.
Amita S, Prabhakar S, Manoj I, Harminder S, Pavan T. Effect of yoga-Nidra on blood glucose level in diabetic patients. Indian J Physiol Pharmacol 2009;53:97-101.  Back to cited text no. 43
    
44.
Kurian J, Mohanthy S, Nanjumdaiah RM. Mechanism of action of yoga on prevention and management of type 2 diabetes mellitus: Narrative review. J Bodyw Mov Ther 2022;29:134-9.  Back to cited text no. 44
    
45.
Kiecolt-Glaser JK, Christian L, Preston H, Houts CR, Malarkey WB, Emery CF, et al. Stress, inflammation, and yoga practice. Psychosom Med 2010;72:113-21.  Back to cited text no. 45
    
46.
Lee JA, Kim JW, Kim DY. Effects of yoga exercise on serum adiponectin and metabolic syndrome factors in obese postmenopausal women. Menopause 2012;19:296-301.  Back to cited text no. 46
    
47.
Skoro-Kondza L, Tai SS, Gadelrab R, Drincevic D, Greenhalgh T. Community based yoga classes for type 2 diabetes: An exploratory randomised controlled trial. BMC Health Serv Res 2009;9:33.  Back to cited text no. 47
    
48.
Vijayakumar V, Mavathur R, Manjunath NK, Raghuram N. Yoga as a safer form of physical activity in type 2 diabetes mellitus: The bidirectional property of yoga in establishing glucose homeostasis. Int J Yoga 2019;12:174-5.  Back to cited text no. 48
[PUBMED]  [Full text]  
49.
Hegde SV, Adhikari P, Kotian S, Pinto VJ, D'Souza S, D'Souza V. Effect of 3-month yoga on oxidative stress in type 2 diabetes with or without complications: A controlled clinical trial. Diabetes Care 2011;34:2208-10.  Back to cited text no. 49
    
50.
White LS. Reducing stress in school-age girls through mindful yoga. J Pediatr Health Care 2012;26:45-56.  Back to cited text no. 50
    
51.
Rosmond R. Stress induced disturbances of the HPA axis: A pathway to Type 2 diabetes? Med Sci Monit 2003;9:A35-9.  Back to cited text no. 51
    
52.
Gordon LA, Morrison EY, McGrowder DA, Young R, Fraser YT, Zamora EM, et al. Effect of exercise therapy on lipid profile and oxidative stress indicators in patients with type 2 diabetes. BMC Complement Altern Med 2008;8:21.  Back to cited text no. 52
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Methodology
Results
Discussion
Conclusion
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed320    
    Printed12    
    Emailed0    
    PDF Downloaded51    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]