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Effects of Yoga Versus Walking on
  Mood, Anxiety, and Brain GABA
                           Levels
       Presented by: Julia Ho, March 7, 2012
Streeter et al. (2010). Effects of Yoga Versus Walking on
Mood, Anxiety, and Brain GABA Levels: A Randomized
Controlled MRS Study., The Journal of Alternative and
Complementary Medicine, 16(11), 1145-1152.
Background
๏ฝ   -previous studies of yoga as a therapeutic
    intervention for anxiety, epilepsy and depression
    ๏ฝ   Khalsa, S. Yoga as a therapeutic intervention: A
        bibliometric analysis of published research studies.
        Indian Journal of Physiology and Pharmacology, 2004.
    ๏ฝ   Craft, L.L. and Landers, D.M. The effect of exercise on
        clinical depression and depression resulting from mental
        illness: A meta-analysis. Journal of Sports and Exercise
        Psychology, 1998.
    ๏ฝ   Yardi, N. Yoga for control of epilepsy. Seizure, 2001.
Background
๏ฝ   Large body of research on the beneficial effects of
    exercise on depression and anxiety
    ๏ฝ   Craft, L.L., Landers D.M. The effect of exercise on clinical
        depression and depression resulting from mental illness:
        A meta-analysis. Journal of Sports Exercise
        Psychology, 1998.
Background
๏ฝ   Medications which increase ฮณ-Aminobutyric acid
    (GABA) activity in the brain are used in depression
    and anxiety treatment
    ๏ฝ   Vallium and Librium bind to the same neuroreceptors
        which GABA bind to
๏ฝ   GABA is a neurotransmitter in the brain which
    functions to inhibit activity in neurons
Objectives
๏ฝ   Are changes in mood, anxiety and GABA levels are
    specific to yoga or related to physical activity?
Methodology
๏ฝ   Subjects recruited from the Boston area community by
    newspaper ads, flyers and Internet
๏ฝ   Eligibility: healthy subject with no significant
    medical/psychiatric disorders, 18-45 years old
๏ฝ   Exclusionary criteria: any yoga practice in the previous 3
    months or a lifetime history of one yoga session/week for
    โ‰ฅ4 weeks, current participant in psychotherapy, prayer
    groups, or mind-body disciplines, neurological disorders
    or medical condition that would compromise subject
    safety, treatment within the previous 3 months with meds
    that might affect the GABA system, alcohol consumption
    > 4 drinks/day and contraindication to magnetic
    resonance evaluation
Methodology
๏ฝ   Recruitment flow chart
Methodology
๏ฝ   Experimental design: clinical trial type study testing
    treatment interventions
๏ฝ   Independent variables: Walking intervention, Yoga
    intervention
    ๏ฝ   Iyengar Yoga sessions: 60-min, 3x/wk (equivalent to 3.0
        METs)
    ๏ฝ   Walking sessions: 60-min, 3x/wk, 2.5 miles per hour on a
        flat surface (equivalent to 3.0 METs)
    ๏ฝ   N.B.: METs (metabolic equivalents) are used to rate and
        compare the physical demands of various activity by the
        American College of Sports Medicine
Methodology
๏ฝ   Dependent variable 1: GABA level
    ๏ฝ   All subject had three magnetic resonance spectroscopy
        (MRS) to obtain GABA levels
        ๏ฝ   Scan 1 at baseline
        ๏ฝ   Scan 2 after 12-week intervention was followed by 60-min yoga
            or walking intervention which was followed by
        ๏ฝ   Scan 3
๏ฝ   Dependent variable 2: Mood and anxiety scales
    ๏ฝ   Taken at weeks 0, 4, 8 and 12 and before each MRS
    ๏ฝ   Mood scale: Exercise Induced Feeling Inventory (EIFI)
        ๏ฝ   Positive Engagement, Revitalization, Tranquility and Physical
            Exhaustion
    ๏ฝ   Anxiety Scale: State scale of the Spielberger State-Trait
        Anxiety Inventory (STAI)
Methodology
๏ฝ   Yoga intervention format: Certified Iyengar yoga
    instructors taught the yoga interventions which were
    monitored for consistency by the researchers
๏ฝ   Walking intervention structure: group sessions
    which sessions walked around the gym perimeter
    ๏ฝ   Between scan 2 and 3, the subjects walked on a treadmill
        set to 2.5 mph with 0 incline
Demographics and Study Participation
Results
๏ฝ   Statistical analysis on:
    ๏ฝ   A GEE (generalized estimating equation) model for
        changes in mood and anxiety scores for each group at
        weeks 0, 4, 5 and 12
    ๏ฝ   Tonic changes in GABA levels: subtracting Scan 1 from
        Scan 2 values; acute changes in GABA level: subtracting
        Scan 2 from Scan 3 values
    ๏ฝ   Tonic and Acute changes in GABA levels
    ๏ฝ   Correlations of mood and anxiety scores with GABA
        levels for each scan
    ๏ฝ   Correlations of tonic and acute changes in mood and
        anxiety scores with tonic and acute changes in GABA
        levels
Results
๏ฝ   Main findings:
    ๏ฝ   the 19 yoga subjects reported greater improvement in
        mood and greater decreases in anxiety than the 15
        subjects in the walking group
    ๏ฝ   There were positive correlations between improved mood
        and decreased anxiety and thalamic GABA levels
    ๏ฝ   The yoga group had positive correlations between
        changes in mood scales and changes in GABA levels
Discussion
๏ฝ   Limitations of the study:
    ๏ฝ   Significantly greater level of physical activity level outside
        the intervention in the walking group compared to the
        yoga group
    ๏ฝ   The higher level of outside activity in the walking group
        could have contributed to the finding of smaller changes
        in mood and anxiety in the walking group as the
        intervention may not have been great enough physical
        challenge given the greater level of outside activity
Discussion
๏ฝ   First study to demonstrate that increased thalamic
    GABA levels are associated with improved mood
    and decreased anxiety
๏ฝ   Effect of yoga intervention on GABA levels may be
    due to the ability of yoga practices to increase
    parasympathetic nervous activity
๏ฝ   Merits future study of yoga on mood disorders and
    other neurotransmitters e.g. norepinephrine and
    sertonin
Conclusion
๏ฝ   Depression is one of the most common mental
    health disorders
๏ฝ   Canadians being diagnosed and treated for
    depression: 2.72 million in 1993 to 7.8 million in
    2000. Amount spent on antidepressants rose from
    $161 million in 1993 to $543 million in 2000.*
๏ฝ   Implications of future research into yoga intervention
    in the treatment of depression could lead to
    significant cost savings and a more generalized
    acceptance of alternative treatments in the
    healthcare system
๏ฝ   *Source: IMS Health statistics

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Effects of yoga versus walking on mood,

  • 1. Effects of Yoga Versus Walking on Mood, Anxiety, and Brain GABA Levels Presented by: Julia Ho, March 7, 2012
  • 2. Streeter et al. (2010). Effects of Yoga Versus Walking on Mood, Anxiety, and Brain GABA Levels: A Randomized Controlled MRS Study., The Journal of Alternative and Complementary Medicine, 16(11), 1145-1152.
  • 3. Background ๏ฝ -previous studies of yoga as a therapeutic intervention for anxiety, epilepsy and depression ๏ฝ Khalsa, S. Yoga as a therapeutic intervention: A bibliometric analysis of published research studies. Indian Journal of Physiology and Pharmacology, 2004. ๏ฝ Craft, L.L. and Landers, D.M. The effect of exercise on clinical depression and depression resulting from mental illness: A meta-analysis. Journal of Sports and Exercise Psychology, 1998. ๏ฝ Yardi, N. Yoga for control of epilepsy. Seizure, 2001.
  • 4. Background ๏ฝ Large body of research on the beneficial effects of exercise on depression and anxiety ๏ฝ Craft, L.L., Landers D.M. The effect of exercise on clinical depression and depression resulting from mental illness: A meta-analysis. Journal of Sports Exercise Psychology, 1998.
  • 5. Background ๏ฝ Medications which increase ฮณ-Aminobutyric acid (GABA) activity in the brain are used in depression and anxiety treatment ๏ฝ Vallium and Librium bind to the same neuroreceptors which GABA bind to ๏ฝ GABA is a neurotransmitter in the brain which functions to inhibit activity in neurons
  • 6. Objectives ๏ฝ Are changes in mood, anxiety and GABA levels are specific to yoga or related to physical activity?
  • 7. Methodology ๏ฝ Subjects recruited from the Boston area community by newspaper ads, flyers and Internet ๏ฝ Eligibility: healthy subject with no significant medical/psychiatric disorders, 18-45 years old ๏ฝ Exclusionary criteria: any yoga practice in the previous 3 months or a lifetime history of one yoga session/week for โ‰ฅ4 weeks, current participant in psychotherapy, prayer groups, or mind-body disciplines, neurological disorders or medical condition that would compromise subject safety, treatment within the previous 3 months with meds that might affect the GABA system, alcohol consumption > 4 drinks/day and contraindication to magnetic resonance evaluation
  • 8. Methodology ๏ฝ Recruitment flow chart
  • 9. Methodology ๏ฝ Experimental design: clinical trial type study testing treatment interventions ๏ฝ Independent variables: Walking intervention, Yoga intervention ๏ฝ Iyengar Yoga sessions: 60-min, 3x/wk (equivalent to 3.0 METs) ๏ฝ Walking sessions: 60-min, 3x/wk, 2.5 miles per hour on a flat surface (equivalent to 3.0 METs) ๏ฝ N.B.: METs (metabolic equivalents) are used to rate and compare the physical demands of various activity by the American College of Sports Medicine
  • 10. Methodology ๏ฝ Dependent variable 1: GABA level ๏ฝ All subject had three magnetic resonance spectroscopy (MRS) to obtain GABA levels ๏ฝ Scan 1 at baseline ๏ฝ Scan 2 after 12-week intervention was followed by 60-min yoga or walking intervention which was followed by ๏ฝ Scan 3 ๏ฝ Dependent variable 2: Mood and anxiety scales ๏ฝ Taken at weeks 0, 4, 8 and 12 and before each MRS ๏ฝ Mood scale: Exercise Induced Feeling Inventory (EIFI) ๏ฝ Positive Engagement, Revitalization, Tranquility and Physical Exhaustion ๏ฝ Anxiety Scale: State scale of the Spielberger State-Trait Anxiety Inventory (STAI)
  • 11. Methodology ๏ฝ Yoga intervention format: Certified Iyengar yoga instructors taught the yoga interventions which were monitored for consistency by the researchers ๏ฝ Walking intervention structure: group sessions which sessions walked around the gym perimeter ๏ฝ Between scan 2 and 3, the subjects walked on a treadmill set to 2.5 mph with 0 incline
  • 12. Demographics and Study Participation
  • 13. Results ๏ฝ Statistical analysis on: ๏ฝ A GEE (generalized estimating equation) model for changes in mood and anxiety scores for each group at weeks 0, 4, 5 and 12 ๏ฝ Tonic changes in GABA levels: subtracting Scan 1 from Scan 2 values; acute changes in GABA level: subtracting Scan 2 from Scan 3 values ๏ฝ Tonic and Acute changes in GABA levels ๏ฝ Correlations of mood and anxiety scores with GABA levels for each scan ๏ฝ Correlations of tonic and acute changes in mood and anxiety scores with tonic and acute changes in GABA levels
  • 14. Results ๏ฝ Main findings: ๏ฝ the 19 yoga subjects reported greater improvement in mood and greater decreases in anxiety than the 15 subjects in the walking group ๏ฝ There were positive correlations between improved mood and decreased anxiety and thalamic GABA levels ๏ฝ The yoga group had positive correlations between changes in mood scales and changes in GABA levels
  • 15. Discussion ๏ฝ Limitations of the study: ๏ฝ Significantly greater level of physical activity level outside the intervention in the walking group compared to the yoga group ๏ฝ The higher level of outside activity in the walking group could have contributed to the finding of smaller changes in mood and anxiety in the walking group as the intervention may not have been great enough physical challenge given the greater level of outside activity
  • 16. Discussion ๏ฝ First study to demonstrate that increased thalamic GABA levels are associated with improved mood and decreased anxiety ๏ฝ Effect of yoga intervention on GABA levels may be due to the ability of yoga practices to increase parasympathetic nervous activity ๏ฝ Merits future study of yoga on mood disorders and other neurotransmitters e.g. norepinephrine and sertonin
  • 17. Conclusion ๏ฝ Depression is one of the most common mental health disorders ๏ฝ Canadians being diagnosed and treated for depression: 2.72 million in 1993 to 7.8 million in 2000. Amount spent on antidepressants rose from $161 million in 1993 to $543 million in 2000.* ๏ฝ Implications of future research into yoga intervention in the treatment of depression could lead to significant cost savings and a more generalized acceptance of alternative treatments in the healthcare system ๏ฝ *Source: IMS Health statistics

Editor's Notes

  1. 751 search results
  2. -200 were assessed for eligibility and 34 completed study
  3. -the study controlled for group effects and interaction time by researchers?-I would have liked to see more detail hereYoga: teachers interaction with students and students interaction with each otherWalking: were participants allowed to chat? Music?Were the sessions of yoga conducted in the same room as the walking?What season was it? Did the 12 weeks span summer versus winter?
  4. Not a robust enough study-age range narrow-majority female-well educated-PARs: Physical activity recall: used to convert subjectโ€™s weekly physical activity outside of the intervention into a METs score: PAR higher for walking groupย p-valueย is theย probabilityย of obtaining aย test statisticย at least as extreme as the one that was actually observed, assuming that theย null hypothesisย is true. One often "rejects the null hypothesis" when the p-value is less than theย significance levelย ฮฑ (Greek alpha), which is often 0.05 or 0.01. When the null hypothesis is rejected, the result is said to bestatistically significant.The t-test assesses whether the means of two groups areย statisticallyย different from each other. This analysis is appropriate whenever you want to compare the means of two groups, and especially appropriate as the analysis for theย posttest-only two-group randomized experimental design.
  5. Inย statistics, aย generalized estimating equation (GEE)ย is used toย estimateย the parameters of aย generalized linear modelย with a possible unknownย correlationย between outcomes.
  6. Did the authors of this study consider the meditation aspect of Iyengar yoga to be the key to the mood elevation rather than the yoga stretches themselves? -no but from my reading of the article I think the subjects were just asked to do poses2) The authors asked the subjects to rate their mood and anxiety, measuring if they feel revitalization, tranquility and anxiety. The environment can play a big role here, was this put into consideration? If not, should they? For example, walking outside at the park vs. On the treadmill or doing yoga with relaxing music. -the walking group walked in the gym and on the treadmill before for scan 2 and 3 -article did not indicate where the yoga classes took place3) The mean age of the subjects were 23.9 for yoga group and 25.6 for the walking group. Does this method possible work best for younger age groups, familiarized with yogaโ€™s relaxing effects through popular culture? Will there be the same effect if done in an old cohort? -further studies need to be done for a wider age group -BKS Iyengar is 914) GABA levels can be affect by diet, was this considered (other than alcohol consumption)? How do the subjectsโ€™ diets differ? (i.e. Vegetarian? Vegan?)ย  -no researchers did control for diet -some studies have been done to show that foods affect GABA levels: AlmondsTreenutsBananasBeefLiverBroccoliBrownRiceHalibutLentilsOats, whole grainOranges, citrus fruitsRicebranSpinachWalnutsWhole wheat, whole grains5) In the future, if a yoga program was implemented for depression or anxiety patients, will there be an issue to have them comply to going to a 12-week long intervention? -yes, compliance would be an issue -unless you did a residential study