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DOI: 10.4172/2157-7595.1000224

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ISSN: 2157-7595

Research
Pilot study Article Open
OpenAccess
Access

Impact of a 10 minute Seated Yoga Practice in the Management of

Diabetes
Rashmi S Mullur1,2* and Donna Ames3,4
1
VA Greater Los Angeles Health Care System, Associate Chief of Integrative Medicine, Los Angeles, USA
2
Department of Internal Medicine, Division of Endocrinology, David Geffen School of Medicine at UCLA, Los Angeles, USA
3
Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, USA
4
Psychosocial Rehabilitation and Recovery Center, VA Greater Los Angeles Health Care System, Los Angeles, USA

Abstract
Objective: We sought to prospectively evaluate the impact of a 10 minute seated yoga program added to
standard comprehensive diabetes care on glucose control and cardiovascular health in the severely ill, medically
complex diabetic population.
Method: A total of 10 patients with type 2 diabetes, ages 49-77, with duration of diabetes >10 years and
haemoglobin A1C >9% (75 mmol/mol) were included in the study. Patients randomized to a yoga intervention were
taught a 10 minute seated yoga practice, were given an explanatory DVD and a fold-out pocket guide to encourage
adherence at home, and were instructed to incorporate the practice as often as they could. The patients in the control
arm were provided information and hand outs on the available yoga classes on campus.
Results: At 3 month clinical follow up, the mean decrease in fasting capillary blood glucose (CBG) was 45%
among yoga participants (-5.2 ± 4.1 mmol/L). Heart rate (HR) dropped by 18% and Diastolic blood pressure (BP)
dropped by 29% in the intervention arm, (-12.4 ± 6.69 and -26 ± 12.05 mmHg, respectively). There were no statistically
significant changes in the haemoglobin A1C, systolic blood pressure, weight, or body mass index in either group.
Conclusion: Our small pilot study reinforces the current medical evidence supporting the use of yoga, combined
with standard care, to improve health outcomes in diabetes.

Keywords: Yoga; Diabetes; Stress reduction; Glycaemic control; added to our program of comprehensive diabetes care for patients
Hypertension; Heart rate; Cardiovascular health with complicated or difficult to manage diabetes, on glucose control
and cardiovascular health. We consented a total of 10 patients with
Introduction type 2 diabetes, ages 49-77, with duration of diabetes >10 years and
The practice of yoga is well established as a mind-body exercise that haemoglobin A1C >9% (75 mmol/mol). Patients were randomized to
improves overall health and promotes stress reduction. Previous studies a yoga intervention or control group; the patients in the yoga arm were
of yoga in patients with type 2 diabetes have shown improvement in taught the10 minute seated yoga practice, were given an explanatory
glucose control, but a significant limitation of these studies is the nature DVD and a fold-out pocket guide to encourage adherence at home, and
of the yoga intervention itself [1,2]. The majority of the trials evaluating were instructed to incorporate the practice as often as they could. The
the benefits of yoga involve vigorous posture-based practices (asana) patients in the control arm were provided information and hand-outs
and/or yogic breath exercises (pranayama) not feasible for most of those on the available yoga classes on campus (Figure 1).
who are severely ill or with complex disease processes. Furthermore, Results
many traditional exercise regimens, even low impact walking or
swimming, remain out of reach for the patients who are wheelchair There were no statistically significant differences in the baseline
bound or otherwise physically unable [3]. characteristics in either group including age, weight, BMI, medications
prescribed, insulin use, and micro vascular or macro vascular
The American Diabetes Association recommends not only complications; 60% of the patients had identified coronary artery
traditional medical intervention but also advocates counselling disease and 80% of the patients had chronic kidney disease. All patients
on healthy lifestyle modification and stress reduction as a part of were using basal insulin with 70% also using prandial insulin (Table 1).
comprehensive diabetes care. Few exercise and stress reduction
regimen are designed specifically for the elderly, severely ill, diabetic At 3 month clinical follow up, the participants in the yoga
population, and even fewer have been evaluated prospectively in the
medical literature [4].
*Corresponding author: Rashmi S Mullur, Department of Internal Medicine, Division
Materials and Method of Endocrinology, David Geffen School of Medicine at UCLA, Los Angeles, CA
90073, USA, Tel: 310-478-3711; Fax: 310-268-4879; E-mail: [email protected],
As part of our patient-centred care initiative, a 10-minute seated [email protected]
yoga program was developed that would be manageable to all Veterans. Received November 16, 2015; Accepted January 11, 2016; Published January
The seated program was designed to include participants of all physical 18, 2016
abilities [5]. The entire sequence included 5 postures coupled with
Citation: Mullur RS, Ames D (2016) Impact of a 10 minute Seated Yoga Practice
deep breathing to allow for increased mind-body awareness in the in the Management of Diabetes. J Yoga Phys Ther 6: 224. doi:10.4172/2157-
participant. Each posture was taught with appropriate modifications for 7595.1000224
participants of varying abilities. The entire sequence took 10 minutes Copyright: © 2016 Mullur RS, et al. This is an open-access article distributed under
to complete. the terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original author and
We prospectively evaluated the impact of this intervention, source are credited.

J Yoga Phys Ther

ISSN: 2157-7595 JYPT, an open access journal Volume 6 • Issue 1 • 1000224
Citation: Mullur RS, Ames D (2016) Impact of a 10 minute Seated Yoga Practice in the Management of Diabetes. J Yoga Phys Ther 6: 224.
doi:10.4172/2157-7595.1000224

Page 2 of 3

Control (mean ± SD) Intervention (mean ± SD) p-value

Age (years) 60 ± 10.34 68.8 ± 5.97 0.14
Duration of Diabetes (years) 13.6 ± 6.8 18 ± 5.48 0.29
Control, n (%) Intervention, n (%)
Men 5 (100%) 4 (80%) 0.37
History of CAD 3 (60%) 3 (60%) 1
4(80%) 4(80%) 1
Stage 2: 2 (40%) Stage 2: 1 (20%) 0.54
History of CKD Stage 3: 1 (20%) Stage 3: 3 (60%) 0.58
Stage 4: 0 (0%) Stage 4: 0 (0%) 1
Stage 5: 1 (20%) Stage 5: 0 (0%) 0.35
Diabetic Medications:
Oral Hypoglycemic Agents 2 (40%) 1 (20%) 0.54
Metformin 2 (40%) 2 (40%) 1
Basal Insulin 5 (100%) 5 (100%) 1
Prandial Insulin 3 (60%) 4 (80%) 0.54
Other 1 (20%) 0 (0%) 0.34
Medications:
Statin Use 4 (80%) 4 (80%) 1
ACE-I/ARB 5 (100%) 5 (100%) 1
Beta-blocker 4 (80%) 4 (80%) 1
Table 1: Baseline characteristics (n=10).

Control Group (n=5) Intervention Group (n=5)

Pre Post p-value Pre Post p-value
Fasting CBG (mmol/L) 15.2 ± 6.4 12.7 ± 2.9 NS 11.5 ± 3.7 6.4 ± 1.0 0.048
HbA1c (%) 10.74 ± 3.36 10.79 ± 1.80 NS 9.72 ± 2.76 8.92 ± 1.42 NS
HbA1c (mmol/mol) 93 ± 36.7 95 ± 19.7 NS 83 ± 30.2 74 ± 15.5 NS
HR 77.8 ± 10.26 86.2 ± 14.18 NS 83 ±11.22 70.6 ± 8.84 0.01
Systolic BP (mmHg) 133.8 ± 12.27 140 ± 13 NS 137.6 ± 14.25 132.4 ± 10.67 NS
Diastolic BP (mmHg) 86.4 ± 9.42 86.4 ± 8.29 NS 89.8 ± 10.66 63.8 ± 9.12 0.02
Weight (lb) 101.97 ± 20.53 105.05 ± 18.42 NS 97.61 ± 17.50 97.07 ± 17.88 NS
BMI (kg/m2) 32.38 ± 6.84 33.70 ± 6.11 NS 31.44 ± 3.48 31.29 ± 3.70 NS
Table 2: Results are expressed as mean ± SD.

± 6.69 and -26 ± 12.05 mmHg, respectively). There were no statistically

significant changes in the haemoglobin A1c, systolic blood pressure,
weight, or body mass index in either group. There were no reported
adverse events in either group (Table 2).

Discussion
Our pilot study reinforces the current medical evidence supporting
the use of yoga, combined with standard care, to improve health
outcomes in diabetes. Ours is the first report to show significant health
benefits of yoga among Veterans with poorly controlled diabetes. The
simplicity and accessibility of this yoga program makes it very useful
and applicable to the general population. The yoga intervention was
easily incorporated into the patients’ daily routines, and the impact
was similar to recently reported cardiovascular benefits from modest
exercise [6].
The positive data from this small pilot study supports the integration
Figure 1: Sample. and evaluation of mind-body stress reduction techniques in the
elderly, ill diabetic population on a larger scale. This population, with
intervention arm showed significant improvements in fasting capillary hemoglobin A1c greater than 9, often fails standard medical treatments
blood glucose (CBG), heart rate (HR), and diastolic blood pressure and requires additional patient-centered interventions such as health
(DBP), compared to the control arm The mean decrease in fasting CBG coaching to encourage adherence and coping with chronic illness [7].
was 45% among yoga participants (-5.2 ± 4.1 mmol/L). HR dropped by Many of these patients are able to achieve short-term improvements in
18% and Diastolic BP dropped by 29% in the intervention arm, (-12.4 glycaemic control with one-on-one attention, but after a few months,

J Yoga Phys Ther

ISSN: 2157-7595 JYPT, an open access journal Volume 6 • Issue 1 • 1000224
Citation: Mullur RS, Ames D (2016) Impact of a 10 minute Seated Yoga Practice in the Management of Diabetes. J Yoga Phys Ther 6: 224.
doi:10.4172/2157-7595.1000224

Page 3 of 3

they are unable to maintain these achievements in the absence of that determine if patients are truly able to incorporate this stress reduction
individualized interaction. The addition of our seated yoga program technique daily as a part of long-term health. Ours is one of very few
provides a sustainable form of stress reduction and exercise that programs that specifically evaluated a stress reduction and exercise
allows patients to improve mind-body awareness. Previous studies program in the very ill diabetic population. We have successfully
have shown that patients with strong mind-body connections have shown that a combination of traditional medical care integrated with
improved cardiovascular risk profiles, which is the ultimate goal for a mind-body exercise technique may be the best approach to tackle
comprehensive diabetes care [8]. the complexities in achieving improved glycaemic control for this
population.
Our study supports the current available literature and has
clearly shown that both blood pressure and fasting blood sugar were Acknowledgement
significantly improved after 3 months of seated yoga. This confirms We would like to thank Nancy Mohler, MBA, Sandy Robertson, RN, MSN,
that even modest enhancements in stress reduction and coping are PH-CNS, and the VHA Office of Patient Centred Care and Cultural Transformation
associated with large improvements in metabolic health. While there Designated Centre of Innovation for creating and sustaining the Breathing-
Stretching-Relaxation (BSR) yoga-based wellness program for the VA-Greater Los
was a trend towards improvement in haemoglobin A1c, it is possible Angeles Healthcare system.
that a larger effect was not seen since the study did not target diet and
post-prandial blood sugar. References
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Longer follow up after the completion of the yoga intervention will

J Yoga Phys Ther

ISSN: 2157-7595 JYPT, an open access journal Volume 6 • Issue 1 • 1000224