subfolder_0/A randomized trial comparing effect of yoga and exercises on quality of life in among nursing population with chronic low back pain.txt

© 2018 International Journal of Yoga | Published by Wolters Kluwer ‑ Medknow
208
Introduction
Nursing profession is the largest chunk 
of health‑care professionals.[1] Physical, 
psychological, 
and 
psychosocial 
challenges contribute to musculoskeletal 
disorders among nurses. Chronic low 
back pain (CLBP) is the most common 
musculoskeletal disorder among the nurses. 
It is reported that 63%–86% of nursing 
professionals suffer from LBP in their 
lifetime.[1,2] CLBP in nurses is multifactorial, 
and the risk factors pertain to lifestyle, 
physical, 
psychological, 
psychosocial, 
and occupational domains, namely, age, 
gender, physical status, smoking, workplace 
stress, awkward postures, poor ergonomics, 
carrying and repositioning of patients, 
prolonged standing, night shifts, working 
without sufficient breaks, and psychological 
stress are important causative/risk factors 
for CLBP in nurses. Nurses are required 
to lift and transport patients or equipment, 
often in difficult environment particularly 
Address for correspondence: 
Assoc. Prof and Head.  
Nitin J Patil, 
Department of Integrative 
Medicine, Sri Devaraj Urs 
Academy of Higher Education 
and Research, Kolar - 563 103, 
Karnataka, India.  
E-mail: [email protected]
Abstract
Background: Chronic low back pain  (CLBP) adversely affects quality of life  (QOL) in nursing 
professionals. Integrated yoga has a positive impact on CLBP. Studies assessing the effects of 
yoga on CLBP in nursing population are lacking. Aim: This study was conducted to evaluate the 
effects of integrated yoga and physical exercises on QOL in nurses with CLBP. Methods: A  total 
of 88 women nurses from a tertiary care hospital of South India were randomized into yoga group 
(n = 44; age – 31.45 ± 3.47 years) and physical exercise group (n = 44; age – 32.75 ± 3.71 years). 
Yoga group was intervened with integrated yoga therapy module practices, 1 h/day and 5 days a week 
for 6 weeks. Physical exercise group practiced a set of physical exercises for the same duration. All 
participants were assessed at baseline and after 6 weeks with the World Health Organization Quality 
of Life‑brief  (WHOQOL‑BREF) questionnaire. Results: Data were analyzed by Paired‑samples 
t‑test and Independent‑samples t‑test for within‑ and between‑group comparisons, respectively, using 
the Statistical Package for the Social Sciences  (SPSS). Within‑group analysis for QOL revealed a 
significant improvement in physical, psychological, and social domains  (except environmental 
domain) in both groups. Between‑group analysis showed a higher percentage of improvement in 
yoga as compared to exercise group except environmental domain. Conclusions: Integrated yoga 
was showed improvements in physical, psychological, and social health domains of QOL better than 
physical exercises among nursing professionals with CLBP. There is a need to incorporate yoga as 
lifestyle intervention for nursing professionals.
Keywords: Exercises, low back pain, nurses, quality of life, yoga
A Randomized Trial Comparing Effect of Yoga and Exercises on Quality of 
Life in among nursing population with Chronic Low Back Pain
Original Article
Nitin J Patil, 
Nagaratna R1, 
Padmini Tekur2, 
Manohar PV3, 
Hemant Bhargav4, 
Dhanashri Patil
Department of Integrative 
Medicine, Sri Devaraj Urs 
Academy of Higher Education 
and Research, 3Department 
of Orthopedics, Sri Devaraj 
Urs Medical College, 
Kolar, 1Medical Director, 
Arogyadhama, S-VYASA 
Yoga University, 2Division 
of Yoga and Life Sciences, 
S-VYASA Yoga University,
4Integrated Centre for Yoga
(NICY), NIMHANS, Bengaluru,
Karnataka, India
in developing nations where lifting aids are 
not always available or practicable. These 
multiple factors contribute toward higher 
prevalence of CLBP in this population.[3] 
CLBP is one of the main concerns, which 
negatively impacts the quality of life (QOL) 
leading to reduced work productivity, 
absenteeism, 
and 
disabilities 
among 
nurses.[4] Harrington and Gill stated that 
LBP is the most common cause of early 
retirement on grounds of ill health, sickness 
absenteeism, job changes, and a fall in the 
work speed among the working population. 
Especially for young nurses, the mental 
demands of work have a critical influence 
on their QOL and workability.[5]
QOL 
measurements 
are 
being 
used 
increasingly relevant in the evaluation of 
disease progression, treatment, and the 
management of musculoskeletal disorders. 
QOL is recognized as a concept representing 
individual 
responses 
to 
the 
physical, 
mental, and social effects of illness on daily 
Access this article online
Website: www.ijoy.org.in
DOI: 10.4103/ijoy.IJOY_2_18
Quick Response Code:
How to cite this article: Patil NJ, Nagaratna R, Tekur P, 
Manohar PV, Bhargav H, Patil D. A randomized trial 
comparing effect of yoga and exercises on quality of 
life in among nursing population with chronic low back 
pain. Int J Yoga 2018;11:208-14.
Received: January, 2018. Accepted: April, 2018.
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Patil, et al.: Yoga for nurses with low back pain
International Journal of Yoga | Volume 11 | Issue 3 | September-December 2018
209
living, which influences the extent of personal satisfaction 
with life circumstances that can be achieved. Measuring 
QOL is recognized as an important add‑on to objectify 
clinical effectiveness in recent clinical trials.[6,7] CLBP is 
a major deterrent for QOL, and the QOL scores correlate 
with pain and disability of CLBP. Furthermore, QOL 
correlated inversely with poor quality of sleep in nursing 
population. Such multifactorial problems of CLBP demand 
a multifaceted approach for management.[8‑10]
Yoga has emerged as a popular mind‑body therapy for 
CLBP as suggested by emerging scientific literature across 
the globe.[11] Yoga adopts a multifaceted approach utilizing 
practices at body (postures), breath (breathing techniques), 
and mind levels  (meditation and relaxation techniques), 
respectively. According to national surveys, yoga practice 
and research have increased exponentially and in the last 
decade with over 10 million Americans practicing yoga for 
health reasons in 2002 and over  13 million in 2007.[11‑13] 
Literature review reveals that viniyoga, hatha yoga, Iyengar 
yoga, and integrated yoga are the most commonly used 
forms to treat LBP.[14‑16]
In a systematic review, Chou and Huffman concluded 
that there was a fair evidence reflecting efficacy of 
yoga therapy in subacute or CLBP.[17] In another similar 
review 
which 
included 
four 
randomized 
controlled 
trials  (RCTs), it was observed that the intervention by 
Iyengar yoga and viniyoga for a period of 12–24  weeks 
was beneficial in CLBP.[15] Yet, another meta‑analysis 
consisting of eight RCTs by Cramer et  al. found strong 
evidence for short‑term effectiveness  (pain, back‑specific 
disability, and global improvement parameters) and 
moderate evidences (back‑specific disability) for long‑term 
effectiveness of yoga on CLBP. Yoga was not found to be 
associated with serious adverse events.[18]
A study by Tekur et  al. had observed usefulness of yoga 
intervention in improving QOL in patients with CLBP. 
However, this study was used in general population with 
intense residential yoga intervention. We did not come 
across any study that has assessed the same in nursing 
population with an OPD or outdoor setup intervention 
(1 h/day). As discussed earlier, nursing population is more 
prone for CLBP due to specific demands of the occupation.
Thus, the present randomized controlled study was planned 
to compare the effect of integrated yoga and physical 
exercise of similar intensity on QOL of nurses suffering 
from LBP.
Methods
Subjects
This study was conducted among nursing population, 
who were diagnosed by an orthopedician to be suffering 
from CLBP. Participants were working in the tertiary 
care teaching hospital in Kolar district of Karnataka state 
in India. They were randomly divided into two groups: 
yoga (n  =  44; age  –  31.45  ±  3.47  years) and physical 
exercise (n = 44; age – 32.75 ± 3.71 years) using random 
number generator  (www.randomizer.org). Participants in 
the two groups did not differ much in relation to their age, 
education, or duration of illness between the groups as 
shown in Table 1.
Two groups’ randomized controlled single‑blind design was 
followed with participants from both the groups (yoga and 
exercise) receiving intervention for 6  weeks. Assessments 
for QOL were performed at two points of time at baseline 
and after 6 weeks of interventions. The statistician and the 
interviewer were unaware of the allocation status of the 
participants.
The inclusion requirements were as follows:  (a) female 
nurses with diagnosis of either nonspecific LBP, lumbar 
spondylosis, or intervertebral disc prolapse, suffering 
from LBP for 3  months or more as diagnosed by an 
orthopedician and  (b) knowledge of English, Hindi, 
and Kannada language. The exclusion criteria were as 
follows:  (a) pain due to organic causes such as infective 
and inflammatory conditions, metabolic disorders, and 
posttraumatic condition,  (b) patients with degenerative 
disorders of muscles,  (c) patients with comorbid cardiac 
or neuropsychiatric illness,  (d) history of major surgery 
or injury in the past, (e) pregnant women, and (f) patients 
with neurological complications of CLBP.
Written informed consent was taken from all the 
participants before the study and Institutional Ethical 
Clearance was obtained.
Study profile
From January 2015 to December 2016, nurses were 
screened and referred by the orthopedician. Out of 176 
nurses referred for the study, 88 satisfied the study criteria. 
Table 1: Sociodemographic and clinical variables 
comparison between yoga and exercises
Variables
Yoga
Exercises
Number of participants (only female)
44
44
Age (mean±SD)
31.45±3.47
32.75±3.71
Education
ANM
8
3
GNM
28
32
Bachelor of nursing
8
9
CLBP
3 months‑1 year
34
37
>1 year
10
07
Causes
Nonspecific/muscle spasm
37
35
Lumbar spondylosis
6
3
Intervertebral disc prolapse
4
3
SD=Standard deviation, ANM=Auxiliary nursing midwifery, 
GNM=General nursing midwifery, CLBP=Chronic low back pain
Patil, et al.: Yoga for nurses with low back pain
International Journal of Yoga | Volume 11 | Issue 3 | September-December 2018
210
Informed consent was obtained. Baseline assessments 
were done, and they were randomly allocated to yoga 
(n  =  44) and control  (n  =  44) groups. They underwent 
intervention  (either integrated yoga or physical exercise) 
for 6  weeks; repeat assessments were performed on both 
groups. There were no dropouts in the study. Figure  1 
provides a flow diagram of the study profile.
Materials
Assessment
The World Health Organization Quality of Life‑brief 
(WHOQOL‑BREF) questionnaire English and Kannada 
version was used to assess the QOL of the participants.
WHOQOL‑BREF developed by the WHO is a standardized 
comprehensive 
instrument 
for 
assessment 
of 
QOL 
comprising 26 items. The scale provides a measure of 
an individual’s perception of QOL on four domains: 
(1) physical health  (seven items),  (2) psychological 
health  (six items),  (3) social relationships  (three items), 
and  (4) environmental health  (eight items). In addition, it 
also includes two questions for “overall QOL” and “general 
health” facets. The domain scores are scaled in a positive 
direction (i.e., higher scores denote higher QOL). The range 
of scores is 4–20 for each domain. The internal consistency 
of WHOQOL‑BREF ranged from 0.66 to 0.87 (Cronbach’s 
alpha coefficient). The scale has been found to have good 
discriminant validity. It has good test–retest reliability and 
is recommended for use in health surveys and to assess the 
efficacy of any intervention at suitable intervals according 
to the need of the study.[19,20]
Intervention
Integrated approach of yoga therapy  (IAYT) is based on 
the basic principle that there are five layers of the existence 
to human beings, namely, Annamaya Kosa  (physical 
level), Pranamaya Kosa  (subtle energy level), Manomaya 
Kosa (emotional level), Vijnanamaya Kosa  (level of 
intellect), and Anandamaya Kosa  (level of bliss). Yogic 
pathophysiology propounds that the disturbances at the 
emotional level  (adhi) percolate to the physical level 
(vyadhi) through the layer of prana. Furthermore, all layers 
are interrelated and they affect each other indirectly. The 
IAYT is an approach which consists in not only dealing 
with physical layer but also includes using techniques to 
operate on different layers of our existence. The practices 
at body level  (Annamaya Kosa) include yogasanas, 
loosening practices, at subtle energy level  (Pranamaya 
Kosa) include breathing practices and pranayama, and 
at the mind level  (Manomaya Kosa) are meditations and 
relaxation techniques.
A 1‑h integrated yoga therapy module  (IYTM) was 
designed after reviewing the literature in the field of yoga 
and LBP by utilizing the components of yoga at the body, 
subtle energy, and mind level, respectively. The designed 
IYTM was validated by subject experts.[21] Tekur et  al. 
used as a similar intervention in an earlier study.[22] This 
yoga module was practiced 5 days a week for 6 weeks. The 
details of yoga practice are provided in Table 2.
Self and physician refered nursing professionals with CLBP 
(Recruitment Period :  January 2015  to December 2016)
Assessed for  Inclusion and Exclusion criteria, 
Obtained informed consent form
Randomly allocatted to Yoga and Exercise group
Outcome measures were assessed at baseline for All 88 subjects
Group 1 - Yoga; n = 44
Group 2 Exercise; n = 44
Intervention: 1 Month (1 Hour per Day / 5 Days a week)
Group1 - IYTM  for CLBP
Group 2 - Physical Exercise
Assessement of outcome measures were repeated
Statistical Analysis
Report writting
Figure 1: Trail profile
Table 2: Intervention: Integrated yoga therapy module 
versus physical exercises
List of practices in IYTM for CLBP List of physical exercises
Supta udarakarshanasana (folded leg 
lumbar stretch)
Standing hamstring stretch
Shava udarakarshanasana (crossed leg 
lumbar stretch)
Cat and camel
Pavanamuktasana 
(wind‑releasing pose)
Pelvic tilt
Setu bandhasana breathing (bridge 
pose lumbar stretch)
Partial curl
Vyaghrasana (tiger breathing)
Piriformis stretch
Bhujangasana (serpent pose)
Extension exercise
Shalabhasana breathing (locust pose)
Quadriceps leg raising
Uttanapadasana (straight leg raise pose) Trunk rotation
Ardha kati chakrasana (lateral arc pose) Double knee to chest
Ardha chakrasana (half wheel pose)
Bridging
Quick relaxation techniques
Hook lying march
Nadi shuddhi (alternate nostril 
breathing)
Single knee to chest stretch
Bhramari (humming bee breath)
Lumbar rotation
Nadanusandhana (A, U, M, AUM 
chanting)
Press up
Deep relaxation technique
Curl ups
Laghoo shankhaprakshalana (yogic 
colon cleansing) (weekly once)
IYTM=Integrated yoga therapy module, CLBP=Chronic low 
back pain
Patil, et al.: Yoga for nurses with low back pain
International Journal of Yoga | Volume 11 | Issue 3 | September-December 2018
211
Control group intervention
Control group practiced physical exercise of similar 
intensity as IYTM for the same duration and frequency 
as shown in Table  2 provides the details of control 
intervention.
Data collection
Data were taken at the same time of the day on 
the 1st and 43rd day. Orientation to yoga program was given 
to the participants for 3  days, and then on the next day, 
predata collection was done after satisfactory performance. 
WHOQOL‑BREF assessments were done on day 1 and 
day 43 (after 6  weeks). A  trained psychologist assisted in 
data collection.
Data analysis
Statistical Package for the Social Sciences (SPSS) - (Version 
21.0., Armonk, NY: IBM Corp.) was used for all analyses. 
Data of all four domains were normally distributed on 
Shapiro–Wilk test. Hence, the parametric tests were used. 
“Paired‑samples t‑test” and “Independent‑samples t‑test” 
were used to analyze within‑  and between‑group data, 
respectively.
Results
Within‑group comparisons in yoga group
Within‑group pre‑  and postcomparison showed that, 
after the yoga intervention, there was a significant 
improvement in three domains of WHOQOL‑BREF, 
namely, physical (P  <  0.01), psychological  (P  <  0.01), 
and social  (P  <  0.01) with a trend of insignificant 
positive impact in environmental domain  (P  =  0.07) 
[Table 3].
Within‑group comparisons in exercise group
Similar to yoga group, exercise group also showed a 
significant improvement in three domains, namely, physical 
(P < 0.01), psychological (P < 0.01), and social (P < 0.01) 
with no significant difference in the environmental domain 
(P = 0.95) [Table 4].
Between‑group comparisons in yoga versus control 
group
Preintervention data
There was a no significant difference between the 
yoga and control groups at the baseline for all the four 
domains of WHOQOL‑BREF:  (a) physical  (P  =  0.296), 
(b) psychological  (P  =  0.987),  (c) social  (P  =  0.661), and 
(d) environmental (P = 0.904) as shown in Table 5.
Postintervention data
There was a significant difference between the yoga and 
control groups after the intervention in the following 
domains of WHOQOL‑BREF:  (a) physical  (P  <  0.01), 
(b) psychological  (P  <  0.01), and  (c) social  (P  <  0.01) 
with the scores of yoga group being higher than 
those of the control group for all the three domains, 
respectively. 
There 
was 
no 
significant 
difference 
between 
the 
groups 
for 
environmental 
domains 
(P = 0.249).
Table 3: Within yoga group (pre and post) comparison of 
World Health Organization Quality of Life‑BREF scores
Variables
Pre/
post
Yoga group
Mean±SD
Percentage change
P
Physical 
domain QOL
Pre
41.27±6.603
44.12
<0.001
Post
59.48±9.041
Psychological 
domain QOL
Pre
34.91±5.356
97.07
<0.001
Post
68.80±13.428
Social domain 
QOL
Pre
43.07±12.705
55.02
<0.001
Post
66.77±12.004
Environmental 
domain QOL
Pre
55.70±5.325
2.81
0.078
Post
57.27±6.028
QOL=Quality of life, SD=Standard deviation
Table 4: Within exercise group (pre and post) 
comparison of World Health Organization Quality of 
Life‑BREF scores
Variables
Pre/
post
Exercise group
Mean±SD
Percentage change
P
Physical 
domain QOL
Pre
39.82±6.377
25.33
<0.005
Post
49.91±8.575
Psychological 
domain QOL
Pre
34.93±7.315
20.89
<0.001
Post
42.23±7.358
Social domain 
QOL
Pre
44.09±8.757
14.49
<0.001
Post
50.48±8.609
Environmental 
domain QOL
Pre
55.84±5.278
0.089
0.957
Post
55.89±5.136
QOL=Quality of life, SD=Standard deviation
Table 5: Between group (yoga vs. exercise) comparison 
of World Health Organization Quality of Life‑BREF 
scores
Variables
Pre/post
Group
Mean±SD
P
Physical 
domain QOL
Pre
Yoga
41.27±6.60
0.296
Pre
Exercise
39.82±6.34
Post
Yoga
59.48±9.04
<0.005
Post
Exercise
49.91±8.57
Psychological 
domain QOL
Pre
Yoga
34.91±5.36
0.987
Pre
Exercise
34.93±7.31
Post
Yoga
68.80±13.43
<0.001
Post
Exercise
42.23±7.36
Social domain 
QOL
Pre
Yoga
43.07±12.70
0.661
Pre
Exercise
44.09±8.76
Post
Yoga
66.77±12.00
<0.001
Post
Exercise
50.48±8.61
Environmental 
domain QOL
Pre
Yoga
55.70±5.33
0.904
Pre
Exercise
55.84±5.28
Post
Yoga
57.27±6.03
0.249
Post
Exercise
55.89±5.14
Patil, et al.: Yoga for nurses with low back pain
International Journal of Yoga | Volume 11 | Issue 3 | September-December 2018
212
Discussion
At the end of 6 weeks of intervention as mentioned before, 
we observed that both the groups showed significant 
improvements in physical, psychological, and social 
domains of WHOQOL‑BREF, whereas the environmental 
domain did not show significant improvements in either 
of the groups. As compared to the control group, patients 
who 
performed 
yoga 
reported 
significantly 
higher 
scores on the psychological domain  (yoga  –  97.7% and 
control – 20.89%). It was further observed that percentage 
improvement in physical and social domains was higher 
in the yoga group as compared to the exercise group 
(physical domain: yoga  –  44.12% vs. control  –  25.33%; 
and social domain: yoga – 55.02% vs. control – 14.49%).
Previously, Tekur et  al.[22] demonstrated the usefulness 
of a 7  day intensive residential integrated yoga in 
improving QOL in 80  patients with CLBP in a highly 
controlled setting where patients were away from their 
occupational and other duties. They observed a significant 
improvement in all the four domains of WHOQOL‑BREF 
in the yoga‑based lifestyle module as compared to physical 
exercise‑based lifestyle change module. One of the 
limitations with such trials is that they are not practical for 
working young nursing population and difficult to replicate 
such studies. In our study, we used 1‑h yoga program 
which included all major components of yoga therapy, 
namely, asanas, pranayama, and relaxation. The exercise 
group also followed similar duration and frequency of 
intervention. We also observed improvement in physical, 
psychological, and social domains in both the groups 
but not in the environmental domain. The percentage 
improvements were higher in yoga group than the exercise 
group for physical, psychological, and social domains, 
respectively. This may be because the intervention offered 
by Tekur et al. was much more intensive than ours and the 
residential setup involved exposure to such an environment 
which was significantly different from the workplace. We 
performed this research in much more pragmatic setup and 
observed similar outcomes.
Underplaying mechanism of integrated yoga therapy 
module
The probable mechanism of action of yoga may be 
through improvement of autonomic functions through 
triggering 
neurohormonal 
mechanisms 
that 
suppress 
sympathetic activity through downregulation of the 
hypothalamic–pituitary–adrenal axis.[23] Mindfulness‑based 
practices may also enhance cognitive flexibility, which may 
further reduce stress, anxiety, and pain, thereby improving 
QOL.[24] Furthermore, the cellular effects of mechanical 
and fluid pressure on structures such as cartilage suggest 
that yoga postures might alter joint function. Low levels of 
intermittent fluid pressure, as occur during joint distraction, 
have been shown in  vitro to decrease production of 
catabolic cytokines, such as interleukin‑1 and tumor 
necrosis factor.[25] Yoga may be one way to provide the 
motion and forces on joints needed to preserve integrity. In 
addition, pranayama, meditations, and relaxation techniques 
following yogasanas help to relax joints and muscles, 
reduce oxidative stress, and calm the mind.[26] This study 
implicates a probable role of integrated yoga therapy in the 
management of patients suffering from CLBP.
In a cross‑sectional study on 501 nurses from different 
hospitals of Turkey, it was observed that there was a positive 
correlation between QOL as assessed by WHOQOL‑BREF 
and job satisfaction  (assessed using Short‑Form Minnesota 
Questionnaire).[27] Similarly, another cross‑sectional study 
on 435 female nurses from five regional centers in Taiwan 
revealed that associations between scores on the sleep‑quality 
and QOL scales were statistically significantly inversely 
correlated.[28] Another survey on 1534 nursing professionals 
from eight different hospitals in Taiwan found that improved 
QOL of nurses translated into better workability (which may 
indirectly contribute to better health‑care service delivery to 
the patients).[29] In the above study, it was also observed that 
mental demands of work were a critical influence on QOL 
and workability, especially in young nursing professionals. 
The authors further recommended countermeasures such as 
enhancing the ability to cope with the job’s mental demands 
for improving and maintaining the workability of nurses.
Yoga may be considered one such intervention which 
has been found useful in enhancing the ability to cope 
with mental demands and thereby improve QOL and 
workability of nurses. An anonymous E‑mail survey 
was conducted between April and June 2010 of North 
American nurses interested in mind‑body training to 
reduce stress.[30] Of the 342 respondents, 96% were women 
and 92% were Caucasian. Most  (73%) reported one or 
more health conditions, notably anxiety  (49%), back 
pain  (41%), gastrointestinal problems such as irritable 
bowel syndrome (34%), or depression (33%). Their median 
occupational stress level was 4 (0 = none and 5 = extreme 
stress). Nearly all  (99%) reported already using one or 
more mind‑body practices to reduce stress. The most 
common mind‑body practices used by the nurses were 
as follows: intercessory prayer  (86%), breath‑focused 
meditation  (49%), healing or therapeutic touch  (39%), 
yoga/tai 
chi/qi 
gong 
(34%), 
or 
mindfulness‑based 
meditation  (18%). The greatest expected benefits were for 
greater spiritual well‑being (56%); serenity, calm, or inner 
peace (54%); better mood (51%); more compassion (50%); 
or better sleep (42%).[30]
Physical domain of WHOQOL‑BREF features such as 
mobility, fatigue, pain, sleep, and work capacity. The higher 
percentage of improvement in the yoga group compared to 
exercises therapy group can be credited to better reduction in 
pain and disability with improvement in spinal flexibility.[31]
Psychological domain features such as feelings, self‑esteem, 
spirituality, thinking, learning, and memory. The higher 
Patil, et al.: Yoga for nurses with low back pain
International Journal of Yoga | Volume 11 | Issue 3 | September-December 2018
213
percentage of improvement in the yoga group compared to 
exercises therapy group may be credited to better reduction 
in stress, anxiety, and depression.[31,32]
Social domain of WHOQOL‑BREF features questions 
relating to problems in interpersonal relationships and 
social support. Yoga also acts like cognitive behavioral 
therapy; this may be the reason for the superior impact of 
yoga intervention compared to physical exercises in nurses 
with CLBP.
Environmental domain deals with problems relating 
to financial resources, physical safety, and physical 
environment such as pollution, noise, and climate. As 
working environment remained same throughout, this 
might have been the reason, we did not able to notice any 
significant changes in the environmental domain in both 
the groups.
Thus, yoga appears to be an integrated therapeutic tool 
and feasible intervention for improving QOL in nursing 
professionals compared to physical exercise as it offers 
holistic approach.
The strengths of the study are as follows:  (a) this 
multidisciplinary study encompasses the fields of yogic 
science, orthopedics, and psychology;  (b) a large sample 
of 88 CLBP patients were enrolled for the study with 
no dropouts,  (c) no earlier study has reported effect 
of integrated yoga intervention on QOL of nurses 
suffering from CLBP;  (d) because the study involved 
a pragmatic approach, the acceptability and adherence 
to therapy were good; and  (e) as yoga and control 
program was delivered through a standard protocol, 
it could be reproduced in the exact way for future 
interventions.
This study has a few limitations, namely: this study was 
a preliminary attempt to assess the response of nursing 
population suffering from CLBP, and future studies 
should incorporate more objective variables such as 
electromyography, radio‑imaging, biochemical measures, 
and other advanced objective variables of autonomic 
functions.
Conclusions
IYTM improves physical, psychological, and social 
health domains of QOL among nursing professionals with 
CLBP more than the physical exercises. There is a need 
to incorporate yoga as lifestyle intervention for nursing 
professionals with CLBP.
Acknowledgments
We are thankful for the management of Sri Devaraj Urs 
Academy of Higher Education and Research, Tamaka, 
Kolar, India, for their support throughout. We acknowledge 
the participants who gave their consent and participated 
in this study. We acknowledge Dr. Ananta Bhattacharyya, 
Dr.  Balaram Pradhan, and Mr. Ravishankar S. for their 
support.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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