Wellness Check: Spirituality

Yoga may improve markers of frailty in older adults

1. In this systematic review, yoga was associated with improvements in gait speed and lower-extremity strength in older adults.

2. However, when yoga was compared to active interventions, such as tai chi and regular exercise, there was no significant improvement in frailty markers.

Evidence Rating Level: 1 (Excellent)

The practice of yoga has demonstrated benefits on various health parameters, including breath control, lung function, and cognition. Although studies have shown that yoga improves balance and mobility in older adults, currently no reviews have examined the effects of yoga on frailty in older adults. As a result, the objective of the present systematic review was to synthesize the evidence regarding the effects of yoga-based interventions on frailty markers in older adults.

Of 6349 identified records, 33 (n=2384 participants) studies were included from various databases from 2006-2022. Studies were included if they were randomized controlled trials that investigated the effects of yoga on one or more domains of frailty, investigated a yoga-based intervention that included at least 1 session of physical postures, and had a mean participant age of 65 years or older. Studies were excluded if they evaluated mindfulness-based stress reduction. The review was performed using PRISMA guidelines. Risk of bias was assessed using the Cochrane revised tool for assessing risk of bias in randomized trials (RoB 2). The quality of the evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). The primary outcome was the impact of yoga on markers of frailty in older adults.

The results demonstrated that, compared to inactivity or education alone, yoga-based interventions were effective at improving gait speed, lower-extremity strength, and lower-extremity endurance in older adults. However, there was less evidence to suggest the effectiveness of yoga on improving other frailty markers, such as balance and handgrip strength. When yoga was compared to an active control group (e.g., formal exercise or tai chi), there was no significant difference in frailty markers. Despite these results, the study was limited by the heterogeneity in the study designs and yoga styles. Nonetheless, the findings of the present study suggested that yoga may be an effective modality in improving frailty markers in older adults.

Yoga supports the wellbeing of individuals with mild cognitive impairment or dementia

1. In this systematic review, most studies found that yoga had a positive effect on variables such as cognition, mood, and balance in patients with mild cognitive impairment (MCI) and dementia.

2. In addition, across the included studies, yoga was found to be a relatively safe intervention in this population. However, yoga-related dizziness may be a concern for some patients.

Evidence Rating Level: 1 (Excellent)

Mild cognitive impairment (MCI) and dementia are neurodegenerative conditions with no known cure. Despite this, patients with these conditions may still benefit from interventions that delay deterioration and support wellbeing. Currently, the benefits of yoga in patients with MCI or dementia are not well understood. As a result, the objective of the present study was to systematically review the literature and synthesize the available evidence on the effects of yoga on health outcomes in patients with MCI or dementia.

Of 1431 identified records, 14 (n=12 quantitative, n=2 qualitative) studies were included from various databases from inception to September 2020. Studies were included if they investigated the influence of yoga on the wellbeing of individuals with MCI or dementia. Studies were excluded if they used qualitative assessments or if the interventions studied were multi-modal or mindfulness-based. The review was performed using PRISMA guidelines. The risk of bias was assessed using the Cochrane Handbook. The primary outcomes were the effects of yoga on cognitive, mental, and physical health, and the overall safety of the intervention.

The results demonstrated that most of the included studies found an improvement in cognition, mood, and balance associated with yoga. Furthermore, yoga was considered a relatively safe intervention. However, yoga-related dizziness was an area of concern in one study. Despite these findings, the study was limited by the high degree of variability in the yoga protocols, which may have affected the overall results. Nonetheless, the present study demonstrated that yoga may be a safe intervention with multiple benefits in individuals with MCI or dementia.

Death anxiety may impact several clinical parameters in cancer patients receiving palliative care

1. In this study, scores on the Death Anxiety and Distress Scale (DADDS) were positively correlated with both religious struggle and dignity-related distress in cancer patients receiving palliative care.

2. However, DADDS scores were not associated with patient demographic factors, including religious affiliation and intrinsic religiousness.

Evidence Rating Level: 2 (Good)

Terminally ill patients may suffer from significant psychological burdens, including death anxiety and distress. Though one of the objectives of palliative care is to address this, the burden of death anxiety has not been well-characterized in these patients. As a result, the objective of the present study was to evaluate the effects of death anxiety on various clinical parameters in cancer patients receiving palliative care.

The present study was an ancillary study to a previous stepped-wedged randomized controlled trial on dignity therapy in the United States. It included a convenience sample of 167 patients who had received the dignity therapy intervention. Patients were included if they were 55 years of age or older, had a cancer diagnosis, were receiving outpatient palliative care, and had a palliative performance scale score (PPS) of >50. Patients were excluded if they were legally blind or cognitively impaired. Patients completed the Death Anxiety and Distress Scale (DADDS), and information on demographic variables, diagnosis, terminal illness awareness, and religious involvement was obtained. Dignity-related distress was assessed with the Personal Dignity Inventory, and existential quality of life was assessed using the Preparation and Completion subscales of the quality of life at end of life (QUAL-E) questionnaire. The primary outcome was the association between death anxiety and several physical and psychosocial factors.

The results demonstrated a positive association between DADDS scores and both religious struggle and dignity-related distress, but a negative correlation with existential quality of life. There was also an association between terminal illness awareness and DADDS scores. However, DADDS scores were not associated with patient demographic factors such as religious affiliation, frequency of prayer, etc. Despite these results, the study was limited by a relatively homogenous convenience sample which may affect generalizability. Nonetheless, the present study demonstrated that quantifying death anxiety may play an important role in understanding the psychological burden experienced by cancer patients.

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