Isometric yoga improves the fatigue and pain of patients with chronic fatigue syndrome who are resistant to conventional therapy: a randomized, controlled trial

Abstract

Background: Patients with chronic fatigue syndrome (CFS) often complain of persistent fatigue even after conventional therapies such as pharmacotherapy, cognitive behavioral therapy, or graded exercise therapy. The aim of this study was to investigate in a randomized, controlled trial the feasibility and efficacy of isometric yoga in patients with CFS who are resistant to conventional treatments.

Methods: This trial enrolled 30 patients with CFS who did not have satisfactory improvement after receiving conventional therapy for at least six months. They were randomly divided into two groups and were treated with either conventional pharmacotherapy (control group, n = 15) or conventional therapy together with isometric yoga practice that consisted of biweekly, 20-minute sessions with a yoga instructor and daily in-home sessions (yoga group, n = 15) for approximately two months. The short-term effect of isometric yoga on fatigue was assessed by administration of the Profile of Mood Status (POMS) questionnaire immediately before and after the final 20-minute session with the instructor. The long-term effect of isometric yoga on fatigue was assessed by administration of the Chalder's Fatigue Scale (FS) questionnaire to both groups before and after the intervention. Adverse events and changes in subjective symptoms were recorded for subjects in the yoga group.

Results: All subjects completed the intervention. The mean POMS fatigue score decreased significantly (from 21.9 ± 7.7 to 13.8 ± 6.7, P < 0.001) after a yoga session. The Chalder's FS score decreased significantly (from 25.9 ± 6.1 to 19.2 ± 7.5, P = 0.002) in the yoga group, but not in the control group. In addition to the improvement of fatigue, two patients with CFS and fibromyalgia syndrome in the yoga group also reported pain relief. Furthermore, many subjects reported that their bodies became warmer and lighter after practicing isometric yoga. Although there were no serious adverse events in the yoga group, two patients complained of tiredness and one of dizziness after the first yoga session with the instructor.

Conclusions: Isometric yoga as an add-on therapy is both feasible and successful at relieving the fatigue and pain of a subset of therapy-resistant patients with CFS.

Trial registration: University Hospital Medical Information Network (UMIN CTR) UMIN000009646.

Keywords: Chronic fatigue syndrome; Fatigue; Fibromyalgia; Isometric yoga; Treatment.

Figure 1

Flow chart outlining participation in this study.

Figure 2

Illustration of the six poses of the isometric yoga program used in this study. The 20-minute isometric yoga program consisted of three parts. 1) The patients practiced being aware of their spontaneous breathing for one minute. 2) The patients practiced six isometric poses 4–6 times: (i) stretching both arms behind the back; (ii) pushing the palms against each other; (iii) pulling the palms away from each other; (iv) pushing the feet against each other; (v) pushing both knees inward with hands on the outside; and (vi) twisting. 3) The patients practiced abdominal breathing for one minute. The postures were practiced slowly in association with exhalation or inhalation with 50% of the maximal physical strength. After the postures were repeated 4–6 times, the patients decreased their physical exertion and returned slowly to the basic position while exhaling.

Figure 3

Acute effects of isometric yoga on fatigue and vigor. A comparison of the fatigue (F) and vigor (V) scores of the Profile of Mood States (POMS) questionnaire for participants in the yoga group before (pre, blue) and immediately after (post, red) the final 20-minute session of isometric yoga with the instructor. ***P < 0.001, **P < 0.01 (paired t test).

Figure 4

Chronic effects of isometric yoga on fatigue. Chalder’s Fatigue Scale (FS) subscale scores for physical symptoms (a), mental symptoms (b), and FS total scores (c) of the yoga and control groups. **P < 0.01 for differences between the pre- and post-intervention scores (paired-sample t test). # P < 0.05, ## P < 0.01 for differences in the scores between the yoga and control groups (independent-sample t test).