Yoga versus standard care for schizophrenia

Review question

Is yoga effective as an add-on treatment for people with schizophrenia?

Background

Yoga comes from ancient India and involves physical postures and breathing exercises to promote balance between mind and body. Yoga has now been widely adopted as a method of relaxation and exercise, improving strength, flexibility, co-ordination, endurance, and breathing control and concentration. Yoga has also been shown to reduce stress and promote health and feelings of well-being. Yoga has been used as a complementary therapy for many health conditions, including improving blood pressure control as well as mental health conditions such as depression and anxiety disorders.

Some research suggests that yoga could also be of benefit as an add-on treatment to reduce the complex symptoms of schizophrenia (such as hearing voices, seeing things, lack of interest in people and activities, tiredness, loss of emotions and withdrawal) and improve the quality of life of people with schizophrenia. Yoga and its use specifically for people with schizophrenia is under-researched.

Study characteristics

We included eight short-term studies (less than six months) that randomised people with schizophrenia to either receive sessions of yoga or standard care in this review. The yoga programmes described varied from 45 minutes to 1 hour in length, and from 8 sessions to a maximum of 36 sessions. We found these studies by electronic searching of the Cochrane Schizophrenia Group's register in January 2015. All studies continued prescribed antipsychotic treatment for the participants.

Key results

Some results suggest that yoga may be beneficial for people with schizophrenia. Yoga may be beneficial to mental state, social functioning and quality of life but the available evidence is weak and needs to be treated with a good degree of caution. No adverse effects were found by the one trial that reported this outcome. Several other important outcomes were not addressed by the studies, including changes in cognition, economic considerations, and daily living activities. There was not enough good-quality evidence in this review to claim that yoga should be prescribed as an add-on to standard care for schizophrenia.

Quality of the evidence

Evidence was limited and weak. The number of included studies was small, and only short-term follow-up was reported. More, larger, and long-term trials that focus on important outcomes are therefore necessary.

Ben Gray, Senior Peer Researcher, McPin Foundation.http://mcpin.org/

Authors' conclusions: 

Even though we found some positive evidence in favour of yoga over standard-care control, this should be interpreted cautiously in view of outcomes largely based each on one study with limited sample sizes and short-term follow-up. Overall, many outcomes were not reported and evidence presented in this review is of low to moderate quality - -too weak to indicate that yoga is superior to standard-care control for the management of schizophrenia.

Read the full abstract...
Background: 

Yoga is an ancient spiritual practice that originated in India and is currently accepted in the Western world as a form of relaxation and exercise. It has been of interest for people with schizophrenia to determine its efficacy as an adjunct to standard-care treatment.

Objectives: 

To examine the effects of yoga versus standard care for people with schizophrenia.

Search strategy: 

We searched the Cochrane Schizophrenia Group Trials Register (November 2012 and January 29, 2015), which is based on regular searches of MEDLINE, PubMed, EMBASE, CINAHL, BIOSIS, AMED, PsycINFO, and registries of clinical trials. We searched the references of all included studies. There were no language, date, document type, or publication status limitations for inclusion of records in the register.

Selection criteria: 

All randomised controlled trials (RCTs) including people with schizophrenia comparing yoga to standard-care control.

Data collection and analysis: 

The review team independently selected studies, quality rated these, and extracted data. For binary outcomes, we calculated risk ratio (RR) and its 95% confidence interval (CI), on an intention-to-treat basis. For continuous data, we estimated the mean difference (MD) between groups and its 95% CI. We employed mixed-effect and fixed-effect models for analyses. We examined data for heterogeneity (I2 technique), assessed risk of bias for included studies, and created 'Summary of findings' tables using GRADE (Grading of Recommendations Assessment, Development and Evaluation).

Main results: 

We included eight studies in the review. All outcomes were short term (less than six months). There were clear differences in a number of outcomes in favour of the yoga group, although these were based on one study each, with the exception of leaving the study early. These included mental state (improvement in Positive and Negative Syndrome Scale, 1 RCT, n = 83, RR 0.70 CI 0.55 to 0.88, medium-quality evidence), social functioning (improvement in Social Occupational Functioning Scale, 1 RCT, n = 83, RR 0.88 CI 0.77 to 1, medium-quality evidence), quality of life (average change 36-Item Short Form Survey (SF-36) quality-of-life subscale, 1 RCT, n = 60, MD 15.50, 95% CI 4.27 to 26.73, low-quality evidence), and leaving the study early (8 RCTs, n = 457, RR 0.91 CI 0.6 to 1.37, medium-quality evidence). For the outcome of physical health, there was not a clear difference between groups (average change SF-36 physical-health subscale, 1 RCT, n = 60, MD 6.60, 95% CI -2.44 to 15.64, low-quality evidence). Only one study reported adverse effects, finding no incidence of adverse events in either treatment group. This review was subject to a considerable number of missing outcomes, which included global state, change in cognition, costs of care, effect on standard care, service intervention, disability, and activities of daily living.

Share/Save