The Effects of Yoga on Impairments of Body Function, Activity Limitations and Participation Restriction for People with Multiple Sclerosis: A Review

Background: A growing body of evidence suggests positive effects for physical activity and structured exercise for people with MS (pwMS). Yoga is a form of structured exercise which is popular among pwMS. The maintenance of static and dynamic postures in Yoga may enhance flexibility, balance and strength. Relaxation and breathing control may also influence mood and sleep.

Objectives: This review aims to examine the outcomes of Yoga on impairments of body function and structure, activity limitations and participation restrictions in pwMS. It will also assess the quality of research in this area.

Methods: A systematic review of the literature was conducted. Searches were carried out in AMED, Web of Science, Sports Discus, Psych Articles, CINAHL and MEDLINE. Quality was assessed using the PEDRO scale and the Cochrane risk of bias tool. Studies were included if they were a randomised control trial (RCT), there was a yoga intervention group and all participants had a definite diagnosis of MS. Trials that were not published in English were excluded. 

Results: Seven RCTs with sample sizes ranging from x to y were included in this review. Participants generally had EDSS scores of ≤6.5 however the majority of participants had EDSS ≤4. Outcome measures varied across the included studies. Within the domain of body function, statistically greater effects than no intervention were found on balance, pain, anxiety and depression. Limitations in activities, namely walking endurance and speed, were similarly shown to improve more in the yoga groups. Positive results were found for participation with regards to reduced fatigue impact and improved quality of life. The included studies exhibited moderate-high bias with an average PEDRo score of 4.3. No adverse effects were reported in any of the included RCTs. 

Conclusions: Yoga has a positive effect on body function, activity limitations and participation. However due to the poor methodological quality of the included studies, further robust trials are required to confirm these findings. The lack of adverse events in any of the trials suggests that yoga is a safe option for people with MS. Further studies of those with greater mobility limitations are needed.