Yoga Mimamsa

ORIGINAL ARTICLE
Year
: 2022  |  Volume : 54  |  Issue : 1  |  Page : 4--11

Integrated effect of yoga and mindfulness meditation on pain, functional disability, and spinal flexibility in computer users with chronic low back pain: A prospective randomized active control trial


Chametcha Singphow1, Satya Prakash Purohit2, Padmini Tekur1, Suman Bista3, Surya Narayan Panigrahy4, Nagarathna Raghuram1,  
1 Department of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana Samsthana, Bengaluru, Karnataka, India
2 Department of Yoga and Humanity, Swami Vivekananda Yoga Anusandhana Samsthana, Bengaluru, Karnataka, India
3 Department of Integrative Medicine, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
4 Department of Rehabilitation, Narayana Institute of Cardiac Sciences, Bengaluru, Karnataka, India

Correspondence Address:
Satya Prakash Purohit
Department of Yoga and Humanity, Swami Vivekananda Yoga Anusandhana Samsthana, Prashanti Kutiram, Vivekananda Road, Kalluballu Post, Jigani, Anekal, Bengaluru - 560 105, Karnataka
India

Abstract

Introduction: Chronic low back pain (CLBP) is two and a half times more prevalent in the working population than in nonworking population. The 1-year prevalence of low back pain (LBP) in working population ranges from 23% to 38%. However, the 1-year prevalence in computer professionals was found to be 31%–54%. Studies have demonstrated the vast mental and physiological health advantages associated with yoga. Objective: We planned to investigate the effect of yoga and mindfulness meditation in computer users with CLBP. Methods: Eighty computer users (42.6 ± 8.45 years of age; suffering from CLBP for 5.20 ± 3.01 years; 51 males and 29 females) were recruited from Bengaluru, Karnataka, India. Subjects were randomized into two groups; yoga and mindfulness meditation/YM group (n = 40) and physical exercise/PE group (n = 40). YM group practiced an integrated module comprising yoga practices and mindfulness meditation, while PE group practiced physical exercises designed for LBP (1 h per day, 3 days per week for 16 weeks). Assessments were done at baseline, after 8 weeks, and after 16 weeks. Results: Seventy-seven participants (39 in YM and 38 in PE) completed the study. Oswestry Disability Index (ODI) scores and Numerical Rating Scale (NRS) scores decreased significantly, and the Sit and Reach Test (SRT) scores improved significantly in both groups after intervention (p < 0.001). Between-group analyses demonstrated that there was a significant difference in ODI scores (YM = 7.28 ± 5.68, PE = 15.53 ± 8.13, P < 0.001), NRS scores (YM = 1.00 ± 0.89, PE = 1.82 ± 0.73, P < 0.001), and SRT scores (YM = 26.41 ± 5.03, PE = 22.82 ± 4.96, P = 0.002) between the YM group and PE group at 16 weeks, favoring the YM group. Conclusion: A 16-week yoga & mindfulness meditation program appeared to be effective in reducing pain and functional disability, and in improving spinal flexibility in computer users with CLBP.



How to cite this article:
Singphow C, Purohit SP, Tekur P, Bista S, Panigrahy SN, Raghuram N. Integrated effect of yoga and mindfulness meditation on pain, functional disability, and spinal flexibility in computer users with chronic low back pain: A prospective randomized active control trial.Yoga Mimamsa 2022;54:4-11


How to cite this URL:
Singphow C, Purohit SP, Tekur P, Bista S, Panigrahy SN, Raghuram N. Integrated effect of yoga and mindfulness meditation on pain, functional disability, and spinal flexibility in computer users with chronic low back pain: A prospective randomized active control trial. Yoga Mimamsa [serial online] 2022 [cited 2022 Dec 9 ];54:4-11
Available from: https://www.ym-kdham.in/text.asp?2022/54/1/4/348197


Full Text



 Introduction



Low back pain (LBP) is a leading cause of disability in both developing and developed countries.[1] The LBP is generally defined as pain and stiffness above the inferior gluteal folds and below the costal margin.[2] The LBP lasting for 12 weeks or more is considered chronic low back pain (CLBP).[3] Studies reported that the lifetime prevalence of LBP is up to 84%, the prevalence of CLBP is about 23%, and the prevalence of LBP with a major disability is up to 12% in the general population.[4] The prevalence of LBP is considered to increase with the age, and one of the reasons may be the increase in activity limitation associated with the age.[3],[5] Studies also found that the prevalence of the LBP is highest in the third decade of life, and it increases with age till 60–65 years and gradually reduces.[6] Similarly, other studies found that the LBP is more prevalent in those in the age range of 40–69 years in females.[4] Recent studies revealed that the CLBP is two and a half times more prevalent in the working population than in nonworking population.[3] LBP is common among working population with a 1-year prevalence ranging from 23% to 38%.[7] The 1-year prevalence of LBP in computer users was found to be 31%–54%.[8] Similarly, a recent study reported that the prevalence of LBP in computer users in universities was 60%.[9] The study also stated that the risk of LBP decreases with an increase in rest or breaks in the computer work.[9] In a study conducted in Punjab, India, the 12-month prevalence of LBP was 40.40% in computer users in bank offices.

Several personal and environmental factors were reported as the risk factors associated with CLBP.[6] Although biomechanical factors including postures, gravity, and other physical activities have a major pathogenic role in CLBP, the genetic constitution is also considered an important contributor.[4] As studies showed, CLBP originates in the lumbar intervertebral discs, the sacroiliac joints, and the apophyseal joints.[10] Hence, it is associated with structural pathologies such as intervertebral disc prolapse and endplate fractures.[10] However, recent studies demonstrated that the major cause of CLBP may be the postural habits that generate painful stress concentrations within innervated tissue disruption.[10] Studies reported that the CLBP is also associated with low educational status, job dissatisfaction, low levels of social support in the workplace, stress, anxiety, and depression.[6] The CLBP has become a major challenge for individuals, families, communities, and even the governments.[6]

The most challenging aspects of CLBP are pain and disability.[2] The pain and disability accompanied by CLBP are further associated with psychological factors such as depression, anxiety, stress, and fear.[11] The pain and disability associated with CLBP are one of the major causes of absenteeism from the workplace worldwide.[12] In computer users, it is reported that poor posture may cause structural deformation of the body, muscular contractures, and pain in the back.[13] Further, muscles require movement to maintain coordination. Hence, unnatural long-term sitting postures can result in the deterioration of the intervertebral discs.[13] The mechanism of action of many treatment options for CLBP is unclear, and they were found less effective. It is suggested that surgery and overtreatment should be avoided as they have several side effects and complications.[4] One effective and risk-free option for CLBP may be yoga therapy.

Yoga is a very ancient technique developed to unite the individual consciousness with the universal consciousness; however, studies have demonstrated the vast mental and physiological health advantages associated with it.[14] For some people, yoga is a kind of mind–body technique where meditation reflects stable seated practices and yoga reflects practices that include movement and involvement of the physical body.[15] Yoga, in reality, is a combination of psychological, physical, and spiritual science that gives the holistic development of the human body, mind, and soul.[16] The science and practices of yoga were clearly described by sage Patanjali in the ancient text Patanjali Yoga Sutra. Yoga, according to Patanjali, involves eight limbs namely Yama (abstinences), Niyama (observances), Asana (physical postures), Pranayama (breath regulation), Pratyahara (withdrawal of the senses), Dharana (concentration), Dhyana (meditation), and Samadhi (absorption).[17] However, Asana, Pranayama, and Dhyana have been used commonly for therapeutic purposes nowadays.[18] The multiple subtle aspects including breath regulation, maintenance of postures, awareness, and relaxation which are the major components of yoga therapy have great potential to cure various lifestyle diseases including CLBP.[18]

Similarly, mindfulness meditation practices that have become popular in modern days are rooted in 2500-year-old Buddhist meditation practices.[19] In the historical Buddhist practice, mindfulness meditation involves maintaining awareness every moment and disengaging oneself from strong attachments to the material world. The primary goal of mindfulness meditation in Buddhism is to alleviate suffering and cultivate compassion.[20] Mindfulness is nonjudgmental awareness of the present-moment experience that has been found to improve a wide spectrum of clinically relevant cognitive and health outcomes,[21] including anxiety, depression, and stress.[22] Anapanasati meditation is one of the basic forms of mindfulness meditation. Anapanasati meditation was practiced and taught by Gautama – The Buddha which is nothing but mindfulness of the sensations of one's breathing.[23] Mindfulness-based interventions have also been found to have equal benefits for the management of several chronic illnesses associated with many common psychosocial issues.[24] Further, mindfulness meditation is also reported to be effective in the reduction of chronic pain and restorative positive health.[25],[26]

As discussed earlier, computer users are prone to CLBP due to long-term sitting postures that may cause structural deformation of the body, muscular contractures, and deterioration of the intervertebral discs. Many randomized controlled trials have reported the effectiveness of yoga therapy on the improvement of pain, functional disability, and spinal flexibility in the general population with CLBP.[27],[28],[29],[30],[31] Recent systematic reviews reported yoga to be more effective in pain, disability, depression, and other psychological comorbidities in CLBP compared to usual care or no care.[32],[33],[34] However, in comparison to physical exercise or physical therapy for CLBP and related disability, a recent systematic review and meta-analysis reported that yoga therapy had a similar effect.[35] Therefore, the present study aims to study the integrated or combined effect of yoga and mindfulness meditation on CLBP in computer users in comparison to physical exercise.

 Materials and Methods



Participants and sample size calculation

Eighty computer users (mean age = 42.6 ± 8.45 years; suffering from CLBP for 5.20 ± 3.01 years; 51 males) were recruited from Bengaluru, Karnataka, India. The sample size was calculated based on two earlier similar studies. The calculated sample size for each group was 18 using the Oswestry Disability Index (ODI) score as a variable with an effect size of 1.26.[28] Similarly, the calculated sample size for each group was 24 using Quality of Life as a variable with an effect size of 1.09.[36] The power = 0.95 and alpha = 0.05 were set in both calculations. Considering the possible attrition rate of up to 40%, the final sample size was set as 80; 40 subjects in each group (40 subjects in yoga and mindfulness meditation [YM] group and 40 subjects in the physical exercise [PE] group).

Selection criteria

Subjects in the age range of 25–64 years[31] who use a computer for their professional work for at least 6 h per day, 5 days a week[29] with current LBP persisting at least for 12 weeks with average pain intensity not less than 4 for the previous week on an 11-point Numerical Rating Scale (NRS)[37] with or without radiation to legs[38] were recruited for the study. Subjects having specific causes of LBP including spinal canal stenosis, spondylolisthesis grade II or more, ankylosing spondylitis, moderate-to-severe scoliosis, malignancy, and fracture were excluded.[37] Those with severe obesity, life-threatening comorbid conditions, critical illness, recommended surgical intervention, and the inability of practicing yoga or exercise were also excluded from the study. Similarly, subjects having indications of serious spinal neurologic abnormality (difficulty passing urine; numbness around the back passage, genitals, or inner thighs; numbness, pins, and needles or weakness in both legs; or unsteadiness on feet) were also excluded.[39] In addition, regular practitioners of yoga (at least once a week for 1 month or more in the past 6 months) and women with pregnancy were excluded.

Study design

The study was a prospective, randomized, active-controlled trial with 16 weeks of follow-up, investigating the effect of yoga and mindfulness meditation on pain, functional disability, and spinal flexibility in computer users with CLBP. Eighty subjects satisfying the selection criteria were randomized into two groups: the YM group (n = 40) and the PE group (n = 40) after obtaining signed informed consent from every participant. The allocations were concealed. YM group practiced an integrated module comprising yoga practices and mindfulness meditation intervention for 16 weeks (1 h per day and 3 days per week). Similarly, the PE group practiced a physical exercise module for the same duration. First 8-week sessions were supervised, followed by 8 weeks of home practice assisted by guided videos and audios of their respective module for both groups. The assessors and statisticians were unaware of the intervention assignment status of the subjects. All assessments (ODI, NRS for Pain, and Sit and Reach test [SRT]) were performed at baseline, after 8 weeks, and after 16 weeks for both YM and PE groups. The experimental group subjects were taught yoga and mindfulness meditation, and the control group subjects were taught physical exercise. The institutional ethical clearances from SVYASA Yoga University, Bengaluru, were obtained before starting the trial. The trial was registered in the Clinical Trial Registry India (CTRI/2020/12/029944).

Assessments

All the assessments were done as per standard guidelines. The assessments of ODI, NRS for Pain, and SRT were performed at baseline, after 8 weeks, and after 16 weeks for both YM group and PE group.

Oswestry Disability Index

The ODI is a validated and reliable subjective assessment tool that measures the degree of disability related to lower back pain.[40] The ODI has five-graded ten questions for assessing the degree of disability in ten different areas of living, namely pain intensity, personal care, lifting, walking, sitting, standing, sleeping, sex life, social life, and traveling. Each question is scored in the range of 0–5, where 0 indicates the least amount of disability and 5 indicates the most severe disability. The final index is calculated by dividing the summed score by the total possible score, which is then multiplied by 100 and expressed as a percentage. If every question is not answered, then the denominator is reduced by 5. The final index ranges from 0 to 100. A score of 0–20 reflects minimal disability (patient can cope with the most living activities), 21–40 moderate disability (patient experiences more pain and difficulty while sitting, lifting, and standing), 41–60 severe disability (pain remains the major problem, daily living activities are affected), 61–80 crippled (pain affects all aspects of the life), and 81–100 bed-bound or exaggerating (patients are either bed-bound or exaggerating symptoms). The ODI is a valid and reliable instrument with a reproducibility of 0.90 (95% confidence interval [CI] = 0.85–0.94) and an internal consistency of 0.86 (95% CI = 0.81–0.90).[41]

Numerical Rating Scale for Pain

The Numerical Pain Rating Scale is a simple and universal measurement tool to assess subjective pain. The NRS consists of a 10-cm horizontal straight line presented on a clean white sheet. One end of the straight line marked “0” represents “no pain at all” and the other end marked “10” represents “worst possible pain.” The subject is asked to indicate his/her pain by marking a dot on the line anywhere between 0 and 10 based on the intensity of pain that he/she is experiencing.

Sit and Reach Test

The SRT measures the flexibility corresponding to the hamstring muscles and lower spine of a patient with LBP. The SRT was performed using a metal Sit and Reach apparatus. The subject sits on the floor with his legs extended toward the Sit and Reach apparatus touching it. The subject then bends forward to his/her maximum capacity pushing the indicator forward with his/her fingers keeping the elbows straight. The distance covered is then measured in centimeters. The SRT is a valid and acceptable objective measure of flexibility with moderate criterion-related validity.[42] The test also has a moderate correlation (r = 0.64) with hamstring flexibility.[43]

Interventions

Yoga and mindfulness meditation group

YM group practiced an integrated module comprising yoga practices and mindfulness meditation intervention, 1 h per day, 3 days per week for 16 weeks. First 8-week sessions were supervised, followed by 8 weeks of home practice of the same assisted by the guided videos and audios of yoga and mindfulness meditation. This module includes yoga postures (Asana), mindfulness meditation on breath (Anapanasati), and relaxation specifically designed to reduce stress, pain, functional disability, and spinal stiffness in LBP. The yogic concept of stress, disease, and lifestyle was described to the YM group. They also got lifestyle advice based on yoga philosophy to improve mental and physical health. The details of the program are provided in [Table 1].{Table 1}

Physical exercise group

The PE group practiced a physical exercise module, 1 h per day, 3 days per week for 16 weeks. As in the YM group, the first 8-week physical exercise sessions were supervised, followed by 8 weeks of home practice of the same assisted by the guided videos and audios. The module was designed to improve the mechanical structure of the lower spine. The physical exercises included in the module were those with matched metabolic equivalents to the yoga postures given to the YM group. The PE group was also given health education and lifestyle advice as per the conventional norms. [Table 1] provides details of the physical exercise program.

The above intervention programs (yoga and mindfulness meditation and physical exercise) were an add-on to conventional management.

Statistical analysis

Data were analyzed using Statistical Package for Social Sciences (SPSS) – version 24, IBM Corporation Business Analytics Software portfolio, Chicago, Illinois, USA. We analyzed the data using the per-protocol approach in study completers. Study completers were defined as those who provided both baseline and 16 weeks' data (n = 77). The analysis was performed by applying repeated measures analysis of variance with a between-subject fixed-effects factor with two levels (yoga and mindfulness meditation and physical exercise) and time as the within-subject fixed-effects factor with three levels (baseline, 8 weeks, and 16 weeks).

 Results



Out of 203 screened, 80 subjects matching our selection criteria were randomized into two groups; yoga and mindfulness meditation (n = 40) and physical exercise (n = 40). 77 participants (39 in YM group [mean age = 43.74 ± 7.26] and 38 in the PE group [mean age = 41.47 ± 9.53]) completed the study. The reasons for dropouts are presented in the trial profile [Figure 1]. There was no difference in demographic variables between the YM and PE groups. [Table 2] provides the demographic details of the subjects.{Figure 1}{Table 2}

Oswestry Disability Index

Within-group analyses revealed that there was a significant reduction in ODI score in 8 weeks as well as in 16 weeks in both YM group and PE group. In YM group, the ODI scores reduced by 57.83% (51.08 ± 14.85–21.54 ± 9.99, P < 0.001) in 8 weeks and by 85.75% (51.08 ± 14.85–7.28 ± 5.68, P < 0.001) in 16 weeks. However, in the PE group, the score reduced by 40.47% (55.66 ± 16.99–33.13 ± 11.58, P < 0.001) in 8 weeks and by 72.10% (55.66 ± 16.99–15.53 ± 8.13, P < 0.001) in 16 weeks [Table 3].{Table 3}

Between-group analyses demonstrated that there was a significant difference in ODI scores between the groups at the end of 8 weeks and the end of 16 weeks, favoring the YM group. The ODI score reduced significantly in 8 weeks (YM = 21.54 ± 9.99, PE = 33.13 ± 11.58, P < 0.001) as well as in 16 weeks (YM = 7.28 ± 5.68, PE = 15.53 ± 8.13, P < 0.001) in YM group as compared to the PE group [Table 4].{Table 4}

Numerical Rating Scale for Pain

There was a significant reduction in the NRS scores in 8 weeks as well as in 16 weeks within YM group and PE group. In YM group, the NRS score reduced by 52.24% (5.59 ± 1.21–2.67 ± 0.98, P < 0.001) in 8 weeks and by 82.11% (5.59 ± 1.21–1.00 ± 0.89, P < 0.001) in 16 weeks. However, in the PE group, the score reduced by 40.58% (5.84 ± 1.35–3.47 ± 0.95, P < 0.001) in 8 weeks and by 68.84% (5.84 ± 1.35–1.82 ± 0.73, P < 0.001) in 16 weeks [Table 3].

Between-group analyses demonstrated that there was a significant difference in NRS scores between the groups at the end of 8 weeks and the end of 16 weeks, favoring the YM group. The NRS scores reduced significantly in 8 weeks (YM = 2.67 ± 0.98, PE = 3.47 ± 0.95, P < 0.001) as well as in 16 weeks (YM = 1.00 ± 0.89, PE = 1.82 ± 0.73, P < 0.001) in YM group as compared to PE group [Table 4].

Sit and Reach Test

The results of our within-group analysis revealed that there was a significant improvement in SRT score in 8 weeks as well as in 16 weeks in both YM group and the PE group. In YM group, the SRT score increased by 123.54% (8.03 ± 5.09–17.95 ± 5.19, P < 0.001) in 8 weeks and by 228.89% (8.03 ± 5.09–26.41 ± 5.03, P < 0.001) in 16 weeks. However, in the PE group, the score increased by 84.67% (8.55 ± 4.48–15.79 ± 4.94, P < 0.001) in 8 weeks and by 166.90% (8.55 ± 4.48–22.82 ± 4.96, P < 0.001) in 16 weeks [Table 3].

The results of the between-group analysis showed that there was no significant difference in SRT scores between the groups at the end of 8 weeks. However, at the end of 16 weeks, there was a significant difference in SRT scores between the groups, favoring the YM group. The SRT score increased significantly in 16 weeks (YM = 26.41 ± 5.03, PE = 22.82 ± 4.96, P = 0.002) in YM group as compared to the PE group [Table 4].

 Discussion



In the current study, there was a significant reduction in ODI score in 8 weeks as well as in 16 weeks within both YM and PE groups. There was a significant difference in ODI scores between the groups at the end of 8 weeks and the end of 16 weeks, favoring the YM group. Similarly, there was a significant reduction in the NRS scores in 8 weeks as well as in 16 weeks within the YM group and PE group. There was a significant difference in NRS scores between the groups at the end of 8 weeks and the end of 16 weeks, favoring the YM group. Further, there was a significant improvement in SRT score in 8 weeks as well as in 16 weeks in both YM group and the PE group. There was no significant difference in SRT scores between the groups at the end of 8 weeks. However, at the end of 16 weeks, there was a significant difference in SRT scores between the groups, favoring the YM group.

In an earlier similar study, the ODI score reduced significantly by 48.76% in the yoga group after a 1-week intensive residential yoga program comprising asanas (physical postures), Pranayamas (breathing practices), meditation, etc., with significant differences between groups, favoring yoga group.[28] In our study, the ODI score was reduced by 57.83% in 8 weeks and by 85.75% in 16 weeks in the YM group with significant between-group differences, favoring the yoga group. The result of the current study is in line with the earlier study. The greater reduction in our study may be because of the longer duration of intervention and the extended practice of mindfulness meditation. In the earlier study, there was a nonsignificant reduction (8.09%) in ODI scores within the PE group.[28] However, our study showed a significant reduction within the PE group (40.47% in 8 weeks and 72.10% in 16 weeks).

The longer duration of physical exercise may be the reason for significant improvement in the PE group too. However, in both studies, significantly greater improvement in the yoga group was observed as compared to the PE group. The greater effectiveness of yoga over exercise in CLBP was supported by another similar study where the yoga group had significantly greater improvement in Roland's disability score than the exercise group after 12 weeks of intervention.[27]

Similarly, another earlier study tried to investigate the effect of the yoga program consisting of specific asana, pranayama, meditation, counseling for back pain, and lectures on yoga philosophy in patients with CLBP.[30] In this study, the NRS score for pain reduced significantly within both yoga (49%) and PE (17.5%) groups with significant between-group differences, favoring the yoga group.[30] In the current study, the NRS score was reduced by 52.24% in 8 weeks and by 82.11% in 16 weeks within the YM group with between-group differences, favoring the YM group. Within the PE group, the score reduced significantly to 40.58% in 8 weeks and 68.84% in 16 weeks. In both studies, the greater improvements in the yoga group show the greater effectiveness of yogic practices over physical exercise. However, greater improvement within both groups in our study compared to the earlier study[30] indicates the benefit of a longer duration of intervention.

In the current study, the SRT score increased by 123.54% in 8 weeks and by 228.89% in 16 weeks within the YM group with a significant between-group difference at the end of 16 weeks, favoring YM group. However, in the PE group, the score increased significantly by 84.67% in 8 weeks and by 166.90% in 16 weeks. An earlier study reported a significant increase (40%) in SRT in the yoga group after 60 days of intervention,[29] with no significant change in the control group. The reasons behind greater improvement within the yoga group in our study may be the additional duration of intervention and extended practice of mindfulness meditation. The significant within-group improvement within the control group in our study may be because we have an active control group, whereas there was a passive control group in the earlier study.

Sarno in his work has cited that ruptured and herniated disks are normal features of the aging spine and 60% of those with such changes never experience any pain symptoms.[44] Patients experiencing pain may benefit from an explanatory model that focuses that their pain is largely under the control of the central nervous system and learning experiences and that one can change emotional processes, potentially leading to a reduction in pain.[45] Yoga may work via downregulation of the sympathetic nervous system (SNS) and hypothalamic–pituitary–adrenal (HPA) axis.[46] Components such as mindfulness and relaxation presented in yoga may be the major contributors to the downregulation of SNS and HPA axis. Health benefits related to mindfulness meditation are associated with enhancements in mechanisms supporting cognitive control, emotion regulation, positive mood, and acceptance.[47] In a part of the present study, we also observed a significant reduction in stress, anxiety, and depression in the yoga group as compared to the control group.[48]

Pain relief through mindfulness meditation was found to be correlated with greater activation in brain regions associated with the cognitive modulation of pain, including the orbitofrontal, subgenual anterior cingulate, and anterior insular cortex.[49] The pain relief is primarily correlated with multiple neural mechanisms supporting the cognitive regulation of ascending nociceptive processing (↑prefrontal and ↑ pregenual anterior cingulate cortex; ↓thalamus) and engages nonopioidergic endogenous systems.[50] Breath regulation also has the potential to bring the mind to a state of mindfulness and reduce the level of stress.[51] Yogic postures also improve muscular strength and flexibility and promote respiratory and cardiovascular functions,[52] which ultimately assist in better musculoskeletal health. Breath regulation, meditation, and relaxation techniques after practicing yoga postures help to relax joints and muscles. However, the physical and mechanical aspects of the yogic postures are quite similar to physical exercises which may be the reason that the physical exercises also demonstrate similar kinds of improvements. Physical exercise is also considered to be a widely accepted method for improving and maintaining holistic health.[46] However, yoga appeared to be more effective than physical exercise in CLBP which may be because of various aspects of yoga that bring about holistic benefits other than the physical ones. Hence, maintaining the postures, breath regulation, mindfulness, and relaxation that help in reducing the psychosocial stresses are the major components that separated yoga from exercises.[18]

The strengths of the current study are long-term intervention, robust methodology, and use of standardized and validated assessment tools and intervention protocols. Limitations of the study are nonsupervised sessions for the last 8 weeks and possible confounding effects of the COVID-19 pandemic.

 Conclusion



Both yoga and mindfulness meditation and physical exercise demonstrated beneficial effects on CLBP. However, yoga and mindfulness meditation was more effective in reducing pain and functional disability and improving spinal flexibility in computer users with CLBP as compared to physical exercise.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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