Protocol for a randomized controlled study of Iyengar yoga for youth with irritable bowel syndrome

Abstract

IntroductionIrritable bowel syndrome affects as many as 14% of high school-aged students. Symptoms include discomfort in the abdomen, along with diarrhea and/or constipation and other gastroenterological symptoms that can significantly impact quality of life and daily functioning. Emotional stress appears to exacerbate irritable bowel syndrome symptoms suggesting that mind-body interventions reducing arousal may prove beneficial. For many sufferers, symptoms can be traced to childhood and adolescence, making the early manifestation of irritable bowel syndrome important to understand. The current study will focus on young people aged 14-26 years with irritable bowel syndrome. The study will test the potential benefits of Iyengar yoga on clinical symptoms, psychospiritual functioning and visceral sensitivity. Yoga is thought to bring physical, psychological and spiritual benefits to practitioners and has been associated with reduced stress and pain. Through its focus on restoration and use of props, Iyengar yoga is especially designed to decrease arousal and promote psychospiritual resources in physically compromised individuals. An extensive and standardized teacher-training program support Iyengar yoga's reliability and safety. It is hypothesized that yoga will be feasible with less than 20% attrition; and the yoga group will demonstrate significantly improved outcomes compared to controls, with physiological and psychospiritual mechanisms contributing to improvements.Methods/DesignSixty irritable bowel syndrome patients aged 14-26 will be randomly assigned to a standardized 6-week twice weekly Iyengar yoga group-based program or a wait-list usual care control group. The groups will be compared on the primary clinical outcomes of irritable bowel syndrome symptoms, quality of life and global improvement at post-treatment and 2-month follow-up. Secondary outcomes will include visceral pain sensitivity assessed with a standardized laboratory task (water load task), functional disability and psychospiritual variables including catastrophizing, self-efficacy, mood, acceptance and mindfulness. Mechanisms of action involved in the proposed beneficial effects of yoga upon clinical outcomes will be explored, and include the mediating effects of visceral sensitivity, increased psychospiritual resources, regulated autonomic nervous system responses and regulated hormonal stress response assessed via salivary cortisol.Trial registrationClinicalTrials.gov NCT01107977.

Review: Effectiveness of mindfulness in improving mental health symptoms of children and adolescents: a meta‐analysis

“…Ten of the included studies were conducted in the United States, two in Australia, and one each in Belgium, Sweden, and Sri Lanka. Two studies (Evans, Cousins, Tsao, Sternlieb, & Zeltzer, ; Malboeuf‐Hurtubise, Achille, Sultan, & Vadnais, ) with published protocols fit our inclusion criteria but have not been completed, and hence not included in this review.…”

Effects of mind–body therapies in children

“…In an ongoing trial of 60 adolescents with IBS, an Iyengar yoga group‐based programme is being compared with a wait‐list/usual care control group. Mechanisms involved in the proposed effects of yoga on clinical outcomes will be explored, such as the mediating effects of visceral sensitivity, and regulated autonomic nervous system responses 35 …”

Pelvic Floor Therapies in Chronic Pelvic Pain Syndrome

“…Evans et al [28] described a planned study of 60 IBS patients (ages 14-26 years) who will be randomly assigned to either a standardized, 6-week, twice weekly Iyengar yoga program or a waitlisted usual-care control group. The primary clinical outcomes of IBS symptoms, quality of life, and global improvement at post-treatment and 2-month follow-up will be compared.…”

“…The primary clinical outcomes of IBS symptoms, quality of life, and global improvement at post-treatment and 2-month follow-up will be compared. Secondary outcomes will include visceral pain sensitivity assessment, functional disability, and psychospiritual variables, including catastrophizing, self-efficacy, mood, acceptance, and mindfulness [28].…”