Randomized Trial of Yoga as a Complementary Therapy for
Pulmonary Tuberculosis
Naveen K. Visweswaraiah & Shirley Telles

 

Objective:
The present prospective, randomized trial compared the efficacy of anti-tuberculosis treatment (ATT) with two separate programs (yoga and breath awareness), on lung capacities and bacteriological status in pulmonary tuberculosis patients.

Methodology:
A total of 1009 pulmonary tuberculosis patients were screened and 73 were alternately allocated, to yoga ( n = 36) or breath awareness (n = 37) groups, with 48 patients completing the 2-month trial. Patients aged between 20 and 55 years, who were sputum-positive on three consecutive examinations, had no prior ATT, and no comorbidities or extrapulmonary tuberculosis were included. In addition to ATT, one group practised yoga (n = 25) and the other practised breath awareness (n = 23) for 6 h per week, each session being 60 min. The main outcome measures were: symptom scores, bodyweight, FVC, FEV
1, FEV 1/FVC%, sputum microscopy, sputum culture, and postero-anterior view of the CXR.

Results:
At the end of 2 months, the yoga group showed a significant reduction in symptom scores (88.1%), and an increase in weight (10.9%), FVC (64.7%) and FEV
1 (83.6%) (P= 0.001, in all comparisons, paired t -test). The breath awareness group also showed a significant (paired t-test) reduction in symptom scores (16.3%, P= 0.02), and an increase in weight (2.1%, P= 0.003) and FEV1(63.8%, P= 0.04). Significantly more patients in the yoga group showed sputum conversion based on microscopy on days 30 and 45 compared to the breath awareness group (P= 0.045 and P= 0.002, respectively, c 2 test). Ten of 13 in the yoga group had negative sputum culture after 60 days compared with four of 19 in the breath awareness group (P= 0.005, c2 test). Improvement in the radiographic picture occurred in 16/25 in the yoga group compared to 3/22 in the breath awareness group on day 60 (P= 0.001, c2 test).

Conclusions:
The improved level of infection, radiographic picture, FVC, weight gain and reduced symptoms in the yoga group suggest a complementary role for yoga in the management of pulmonary tuberculosis.

Keywords:
pulmonary tuberculosis, randomized trial, yoga.

INTRODUCTION
Extensive parenchymal and pleural involvement in pulmonary tuberculosis results in residual fibrotic changes with reduced vital capacity and other lung volumes. Yoga is an ancient Indian science, which includes physical postures (asanas), regulated breathing (pranayama), and meditation (dhyana).  In normal volunteers the practice of a combination of yoga techniques for 2.5 months was shown to increase the maximal voluntary ventilation and FVC.  After 9 months of yoga breathing exercises and postures, 11 patients with chronic severe airway obstruction showed significant improvement in objective tests for exercise tolerance.
The practice of yoga is also known to bring about relaxation and reduce physiological signs of stress. Previous studies have shown that stress can increase vulnerability to infections.
 Hence, the present study examined yoga as a stress-reducing practice, influencing bacteriological status and level of infection as indicated by sputum conversion and changes in the radiographic picture in pulmonary tuberculosis patients. Poor adherence to therapy is the most important cause of anti-tuberculosis treatment (ATT) failure, in both developed  It has been shown that psychological factors such as the effectiveness of the patient–provider interaction influence compliance.
 In the present study, individuals participating in yoga or breath awareness interacted closely with the instructor. Hence, the effects of these programs on patient compliance with ATT during the first 4 months of 10 months’ domiciliary treatment were evaluated. We developed a prospective, randomized trial to compare the efficacy of ATT with one of two programs, yoga or breath awareness, on lung performance, bacteriological status and treatment compliance.