AUTHOR=Majumdar Vijaya , Manjunath N. K. , Nagarathna Raghuram , Panigrahi Suryanarayan , Kanchi Muralidhar , Sahoo Sarthak , Nagendra Hongasandra R. , Giridharan Adithi , Reddy Mounika , Nayak Rakshitha 

TITLE=Adjunct tele-yoga on clinical status at 14 days in hospitalized patients with mild and moderate COVID-19: A randomized control trial

JOURNAL=Frontiers in Public Health

VOLUME=Volume 11 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2023.1054207

DOI=10.3389/fpubh.2023.1054207

ISSN=2296-2565

ABSTRACT=Abstract

Background
The initial insights from the studies on COVID-19 had been disappointing, indicating the necessity of aggravated search for alternative strategies. In this regard, the adjunct potential of yoga has been proposed for enhancing the effectiveness of the standard of care with respect to COVID management. We tested if a telemodel of yoga intervention could aid in better clinical management for hospitalized patients with mild to moderate COVID-19 when complemented with the standard of care.

Methods
This was a randomized controlled trial conducted at the Narayana Hrudalaya, Bengaluru, India on hospitalized patients with mild to moderate COVID-19 infection, enrolled between May 31st and July 22, 2021. Patients (n=225) were randomized in 1:1 ratio  [adjunct tele-yoga (n = 113), or standard of care. The adjunct yoga group received intervention in tele-mode within 4 hours post-randomization until 14 days along with the standard of care. The primary outcome was clinical status at day 14 post-randomization, assessed with a 7-category ordinal scale. The secondary outcome set included: scores on the COVID Outcomes Scale at day 7, follow up for clinical status and all-cause mortality at day 28, post-randomization, duration of days at hospital, 5th day changes postrandomization for viral load expressed as cyclic threshold (Ct), and inflammatory markers and perceived stress scores at day 14.

Results
As compared with the standard of care alone, the proportional odds of having a higher score on the seven-point ordinal scale at day 14 was 1.9 for the adjunct tele-yoga group (95% CI, 1.18-3.18). At day 5, there were significant reductions in CRP (p=0.001) and LDH levels  (P=0.029) in the adjunct yoga group compared to the standard of care alone (Figure 3 and Table S6). CRP reduction was also observed as a potential mediator for the yoga-induced improvement in clinical outcomes. The Kaplan-Meier estimate of all-cause mortality at day 28, was the adjusted hazard ratio [HR], 0.26; 95% CI, 0.05-1.30. 
Conclusion
The observed 1.9-fold improvement in the clinical status at day 14 of patients of COVID-19 with adjunct use of tele-yoga contests its use as a complementary treatment in hospital settings.