The aim of the present study was to evaluate, in a group of healthy women, whether the regular practice of Hatha Yoga could have an impact on their quality of life. It was a transversal controlled study, composed by 25 women, aged between 20 and 59 years, divided in two groups: YOGA (at least six months of Hatha Yoga practice) and CONTROL (non-active women), composed by 13 and 12 volunteers, respectively. The quality of life was assessed through the SF-36 questionnaire. The statistical procedures included the independent t test and the Mann-Whitney tests. The YOGA group presented higher scores in the "body pain" domain and in the general physical score (p < 0.05). It can be concluded that, in the assessed population, the regular practice of Hatha Yoga has positively influenced some aspects of the quality of life.
Keywords: Yoga. Quality of life. Motor activity.
O objetivo do presente estudo foi avaliar, em um grupo de mulheres saudáveis, os efeitos da prática regular de Ioga sobre a qualidade de vida. Tratou-se de um estudo transversal controlado, no qual participaram 25 mulheres saudáveis, com idades entre 20 e 59 anos, divididas nos grupos IOGA (praticantes há pelo menos seis meses) e CONTROLE (sedentárias), compostos respectivamente por 13 e 12 voluntárias. A qualidade de vida foi avaliada utilizando-se o questionário SF-36. Para análise estatística foram realizados o teste t independente e as provas não paramétricas de Mann-Whitney. O grupo IOGA apresentou pontuação significativamente mais elevada no domínio "dor" e no escore físico geral (p < 0,05) do questionário SF-36. Concluímos que, na população avaliada, a prática regular de Hatha Ioga demonstrou ser capaz de influenciar positivamente determinados aspectos da qualidade de vida.
Palavras-chave: Ioga. Qualidade de vida. Atividade motora.
Yoga is an ancient philosophical system originating in India, whose main goal is the development of union between body and mind, aimed at physical and mental well-being (GODOY et al., 2006; CHANAVIRUT et al., 2006). The word "yoga" means "union," and within Indian philosophical and religious systems, it signifies the conscious unification between the material and spiritual aspects of the human being. The ultimate goal of yoga practice consists precisely in achieving this integration (BLAY, 2004).
Over the centuries, various types of yoga have emerged and developed, with distinct approaches and methodologies (GULMINI, 2002). Nevertheless, all share the same common goal — the achievement of human integration — the main distinguishing factor among them being the means and instruments they employ to reach this goal. Among the existing types of yoga, the most popular in the West is Hatha Yoga, which seeks to achieve integration through internal and external mastery of the body (BLAY, 2004). To this end, it draws on a combination of postural exercises ("asanas"), relaxation, and voluntary breath control ("pranayamas") (CHANAVIRUT et al., 2006).
Due to the resemblance of its postures to conventional physical exercises, as well as the results achieved through its techniques on health, physical fitness, and aesthetic standards, Hatha Yoga has become popular in the West and is regarded by many as an alternative form of physical activity (SILVA, 2005). As with conventional gymnastics, it is believed that practicing Hatha Yoga postures can also provide increased muscular strength, flexibility, improved balance, among other physiological adaptations. Indeed, in a literature review, yoga programs demonstrated efficacy in reducing weight and blood pressure, as well as blood glucose and cholesterol levels (HAGINS et al., 2007). However, while the goal of gymnastics is physical health, the goal of yoga is mental health, achieved through physical health (BLAY, 2004). Moreover, the practice of Hatha Yoga has the appeal of being a different experience from traditional aerobic gymnastics and strength training, as it is considered less strenuous and more enjoyable (YANG, 2007).
At the same time, because it is an activity that simultaneously focuses on physical, mental, and spiritual aspects, yoga has been popularly associated with improved quality of life and overall well-being. Accordingly, several authors have set out to evaluate the effects of regular yoga practice on quality of life. Most of these studies have focused on investigating the effects of the practice on the quality of life of individuals with pathological conditions, such as epilepsy (LUNDGREN et al., 2008), cancer (DUNCAN et al., 2008), rheumatoid arthritis (BADSHA et al., 2009), and low back pain (GROESSL et al., 2008), among others. However, few studies have evaluated the effects of regular yoga practice on the quality of life of healthy individuals. Furthermore, we are not aware of studies evaluating the impact of yoga on the quality of life of individuals from the Brazilian population. Therefore, the aim of the present study was to investigate the effects of regular Hatha Yoga practice on the quality of life of a group of healthy women, using the SF-36 questionnaire as the measurement instrument.
This was a controlled cross-sectional study, whose sample consisted of 25 healthy women, aged between 18 and 65 years, non-obese (BMI < 30 kg/m2), and without musculoskeletal limitations that could prevent full participation in yoga classes. The volunteers were divided into two groups: the YOGA group, composed of 13 volunteers who had practiced Hatha Yoga for at least six months and had not practiced and/or had not engaged in any other type of regular physical activity in the previous six months; and the CONTROL group, composed of 12 sedentary volunteers who likewise had not engaged in regular physical activity in the previous six months.
Volunteers in the YOGA group were recruited from the Physical Activity and Quality of Life Program of the Juiz de Fora City Government, MG, and practiced Hatha Yoga in one-hour sessions, twice a week. The classes consisted of asanas (postures), pranayamas (breathing exercises), and meditation. Volunteers in the CONTROL group, in turn, were recruited from among employees of the Juiz de Fora City Government who did not participate in the aforementioned program.
The study was approved by the Human Research Ethics Committee of the Federal University of Juiz de Fora (opinion 180/2008), and all participants signed an informed consent form.
Initially, volunteers underwent a clinical history interview and answered a standardized questionnaire covering aspects related to diagnosed diseases, engagement in physical activity, and length of yoga practice (in the case of the YOGA group). Anthropometric characteristics were then assessed — body mass, height, and body mass index (BMI) — using an anthropometric scale available at the assessment site (Filizola®, São Paulo, Brazil).
Quality of life was measured using the SF-36 questionnaire, a generic quality-of-life assessment instrument that is easy to understand and administer, and that has already been translated into Portuguese and validated for the Brazilian population. It is a multidimensional questionnaire made up of thirty-six items divided into eight domains: functional capacity, physical role functioning, bodily pain, general health, vitality, social functioning, emotional role functioning, and mental health (CICONELLI et al., 1999). These domains, in turn, can be grouped into two overall dimensions: physical and mental component scores (SEVERO, 2006). Higher scores indicate better performance. In the present study, after a prior explanation of the purpose of the questionnaire, volunteers were asked to read and choose the option that best applied to their state of health for each item.
For the analysis of data regarding age and anthropometric variables, the Shapiro-Wilk test was applied first. Since the data showed a normal distribution, the independent Student's t test was applied, with a significance level of 5%. The STATISTICA 8.0 software (StatSoft Inc., Tulsa, OK, United States) was used for this analysis.
Data resulting from the application of the SF-36 questionnaire were described using medians and percentiles. Each of the eight domains was analyzed separately, followed by an analysis of the two overall dimensions: physical and mental component scores. Mann-Whitney non-parametric tests were performed to identify significant differences between the YOGA and CONTROL groups, since the data did not show a normal distribution. A significance level of 5% was likewise considered. The SPSS software, version 11.0, was used for the statistical analysis.
There was no statistically significant difference between the groups regarding body mass, height, and BMI. Furthermore, the groups showed no significant difference regarding age (Table 1).
| Yoga | Control | p value | |
|---|---|---|---|
| Body mass (kg) | 60.3 ± 7.2 | 64.8 ± 8.6 | 0.16 |
| Height (cm) | 159.4 ± 4.8 | 159.4 ± 7.2 | 0.99 |
| BMI (kg/m²) | 23.6 ± 2.7 | 25.4 ± 2.1 | 0.08 |
| Age (years) | 41.1 ± 7 | 43.8 ± 11.9 | 0.49 |
Because some volunteers in the Control group did not return their questionnaires, only nine questionnaires were analyzed for that group. In the Yoga group, by contrast, all questionnaires were analyzed. The results obtained after data analysis can be seen in Table 2.
| SF-36 domains | Yoga | Control | p value | ||||
|---|---|---|---|---|---|---|---|
| Median | P25 | P75 | Median | P25 | P75 | ||
| Functional capacity | 90 | 77.5 | 95 | 85 | 75 | 92.5 | 0.202 |
| Physical role functioning | 100 | 100 | 100 | 100 | 87.5 | 100 | 0.422 |
| Bodily pain | 84 | 68 | 100 | 72 | 51 | 74 | 0.012 * |
| General health | 80 | 72 | 87 | 67 | 59.5 | 82 | 0.061 |
| Vitality | 65 | 50 | 72.5 | 60 | 47.5 | 62.5 | 0.125 |
| Social functioning | 87.5 | 62.5 | 87.5 | 75 | 50 | 87.5 | 0.230 |
| Emotional role functioning | 100 | 50 | 100 | 100 | 50 | 100 | 0.520 |
| Mental health | 72 | 54 | 78 | 72 | 52 | 80 | 0.485 |
| General physical component score | 55.7 | 51.2 | 57.2 | 49.2 | 46.7 | 53.7 | 0.018 * |
| General mental component score | 50.7 | 42.1 | 52.8 | 49.1 | 35.6 | 54.5 | 0.502 |
It can be observed that, for most of the SF-36 questionnaire domains, the median values of the Yoga group were higher than those of the Control group. However, only in the "bodily pain" domain and in the general physical component score did this difference reach statistical significance.
Quality of life is defined by the World Health Organization (WHO) as "individuals' perceptions of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards, and concerns." Still according to the WHO, quality of life is influenced, in a complex manner, by an individual's physical health, psychological state, social relationships, level of independence, among other factors (WORLD HEALTH ORGANIZATION, 1997). Thus, yoga, as a holistic practice that simultaneously encompasses physical, mental, and spiritual aspects, may exert positive impacts on the quality of life of its practitioners. The literature presents several studies relating yoga practice and quality of life in populations with varied pathological conditions, often with positive results. However, in such cases, it can be assumed that these individuals presented prior impairment of their quality of life due to their underlying pathologies and conditions. Accordingly, in the present study we aimed to investigate the effects of regular Hatha Yoga practice on the quality of life of healthy individuals, in order to understand how yoga can contribute to improving the quality of life of this population.
Among the studies whose results corroborate the beneficial effects of yoga practice on the quality of life of healthy people, we may cite that of Hadi and Hadi (2007), in which the authors evaluated the effects of six months of regular Hatha Yoga practice on the quality of life of adults. In that study, the SF-36 questionnaire was used as the measurement instrument. After the intervention period, the authors found a significant increase in all domains of the questionnaire relative to baseline values. Lee et al. (2004) likewise observed improvement in all SF-36 domains after three months of yoga practice in an adult population. The relationship between quality of life and yoga was also evaluated by Oken et al. (2006), though in healthy older adults. These participants underwent a weekly yoga program for six months and were compared with control individuals and with older adults who walked for the same period of time. After the intervention period, a significant improvement in quality of life was observed among the volunteers who practiced yoga, likewise measured through the SF-36 questionnaire.
In the present study, it was observed that yoga practitioners presented significantly higher scores in the "bodily pain" domain and in the general physical component score of the SF-36 questionnaire compared with the CONTROL group. In addition, there was a non-significant trend toward higher scores among volunteers in the YOGA group in the "general health" domain. It can be observed that, in the population studied, yoga practice showed greater influence on physical aspects relative to mental ones. We believe that the absence of a significant difference between the groups regarding mental aspects may be due, among other factors, to the limited specificity of the SF-36 Quality of Life Questionnaire for detecting aspects such as reduced anxiety and stress levels, which were informally reported by the yoga practitioners in this study. Indeed, Smith et al. (2007), in a randomized comparative trial, found, after 10 weeks of weekly Hatha Yoga practice, a significant reduction in anxiety and stress levels, assessed through specific questionnaires, as well as an improvement in quality of life measured through the SF-36 questionnaire.
On the other hand, Chen and Tseng (2008) evaluated the effects of a four-week yoga program on the quality of life of older women, using a shortened version of the SF-36 questionnaire, called the SF-12. After the intervention period, the authors found no significant differences relative to the scores obtained at baseline. It may be assumed that the short intervention period in that study was not sufficient to bring about meaningful changes in the quality of life of the individuals assessed.
Among the limitations of the present study, we may cite the small number of volunteers, which makes it difficult to generalize the results to the entire population of yoga practitioners. This small number is largely due to the difficulty of finding, among the students participating in the Physical Activity and Quality of Life Program of the Juiz de Fora City Government, MG, individuals who practiced only yoga, since they are encouraged by instructors to engage in other types of physical activities as well. Another limitation we may cite is the fact that the sample was composed exclusively of women. This reflected the characteristics of the yoga classes within the aforementioned program, which are made up essentially of adult women. Accordingly, in order to homogenize the groups, we chose to study only female individuals.
Thus, we conclude that, in the population assessed, regular Hatha Yoga practice was able to bring about positive impacts on certain aspects of quality of life. This finding corroborates current evidence that yoga practice can produce positive effects on the quality of life of healthy people. Further randomized controlled studies, with a larger number of participants, are needed for a better understanding of the effects of this practice on the quality of life of healthy individuals, especially within the Brazilian population.
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