title: Effects of yoga on cardiovascular disease risk factors: a systematic review and meta-analysis.
abstract: BACKGROUND
  The aim of this review was to systematically assess and meta-analyze the effects of yoga on modifiable biological cardiovascular disease risk factors in the general population and in high-risk disease groups.
  
  
  METHODS
  MEDLINE/PubMed, Scopus, the Cochrane Library, and IndMED were screened through August 2013 for randomized controlled trials (RCTs) on yoga for predefined cardiovascular risk factors in healthy participants, non-diabetic participants with high risk for cardiovascular disease, or participants with type 2 diabetes mellitus. Risk of bias was assessed using the Cochrane risk of bias tool.
  
  
  RESULTS
  Forty-four RCTs with a total of 3168 participants were included. Risk of bias was high or unclear for most RCTs. Relative to usual care or no intervention, yoga improved systolic (mean difference (MD)=-5.85 mm Hg; 95% confidence interval (CI)=-8.81, -2.89) and diastolic blood pressure (MD=-4.12 mm Hg; 95%CI=-6.55, -1.69), heart rate (MD=-6.59 bpm; 95%CI=-12.89, -0.28), respiratory rate (MD=-0.93 breaths/min; 95%CI=-1.70, -0.15), waist circumference (MD=-1.95 cm; 95%CI=-3.01, -0.89), waist/hip ratio (MD=-0.02; 95%CI=-0.03, -0.00), total cholesterol (MD=-13.09 mg/dl; 95%CI=-19.60, -6.59), HDL (MD=2.94 mg/dl; 95%CI=0.57, 5.31), VLDL (MD=-5.70 mg/dl; 95%CI=-7.36, -4.03), triglycerides (MD=-20.97 mg/dl; 95%CI=-28.61, -13.32), HbA1c (MD=-0.45%; 95%CI=-0.87, -0.02), and insulin resistance (MD=-0.19; 95%CI=-0.30, -0.08). Relative to exercise, yoga improved HDL (MD=3.70 mg/dl; 95%CI=1.14, 6.26).
  
  
  CONCLUSIONS
  This meta-analysis revealed evidence for clinically important effects of yoga on most biological cardiovascular disease risk factors. Despite methodological drawbacks of the included studies, yoga can be considered as an ancillary intervention for the general population and for patients with increased risk of cardiovascular disease.
authors.affiliation: Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany. Electronic address: h.cramer@kliniken-essen-mitte.de.
authors.forename: Holger
authors.initials: H
authors.lastname: Cramer
authors.affiliation: Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany.
authors.forename: Romy
authors.initials: R
authors.lastname: Lauche
authors.affiliation: Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany.
authors.forename: Heidemarie
authors.initials: H
authors.lastname: Haller
authors.affiliation: Immanuel Hospital Berlin, Department of Internal and Complementary Medicine, Berlin, Germany.
authors.forename: Nico
authors.initials: N
authors.lastname: Steckhan
authors.affiliation: Immanuel Hospital Berlin, Department of Internal and Complementary Medicine, Berlin, Germany; Charité-Universitätsmedizin Berlin, Institut für Sozialmedizin, Epidemiologie und Gesundheitsökonomie, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Michalsen
authors.affiliation: Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany.
authors.forename: Gustav
authors.initials: G
authors.lastname: Dobos
mesh_terms: D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000517:prevention & control*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D040242:Risk Reduction Behavior; D015013:Yoga
keywords: Cardiovascular diseases; Hypertension; Meta-analysis; Metabolic syndrome; Type 2 diabetes; Yoga