- Dr. Steffany Moonaz is a yoga therapist and researcher, currently serving as Assistant Director of Academic Research ... moreDr. Steffany Moonaz is a yoga therapist and researcher, currently serving as Assistant Director of Academic Research at the Maryland University of Integrative Health, which offers the nation’s only M.S. in Yoga Therapy. Dr. Moonaz spent eight years at Johns Hopkins University, developing and evaluating a yoga program for individuals with rheumatoid arthritis and osteoarthritis, which has been replicated in collaboration with the National Institutes of Health. She is the founder of Yoga for Arthritis, an organization bringing evidence-based yoga programs to people with arthritis nationwide, as well as educating yoga professionals to work safely and effectively with this population.edit
- James Snowedit
Osteoarthritis (OA) is a common joint disorder for which there is no cure. Current treatments are suboptimal. Exercise is a core treatment for knee OA, with muscle strengthening exercise commonly recommended. Yoga is a mind-body exercise... more
Osteoarthritis (OA) is a common joint disorder for which there is no cure. Current treatments are suboptimal. Exercise is a core treatment for knee OA, with muscle strengthening exercise commonly recommended. Yoga is a mind-body exercise intervention that can improve flexibility, muscle strength, balance, and fitness and potentially reduce symptoms of OA. However, there is a scarcity of robust, high-quality conclusive evidence on the efficacy of yoga in knee OA. We are currently conducting the first randomised comparative effectiveness and cost-effectiveness trial of a yoga program compared with a strengthening exercise program in patients with symptomatic knee OA. This study protocol describes the design and conduct of this trial. The YOGA study is a phase III, single-centre, parallel, superiority, randomised, active-controlled trial which will be conducted in Hobart, Australia. One hundred and twenty-six participants (63 in each arm) aged over 40 years with symptomatic knee OA wil...
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<p>A) Subject standing on foam, B) Wii Balance Board. Four sensors are located in each corner. Center of Pressure is derived as an <i>x</i> and <i>y</i> coordinate measured over time.</p
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<p>Note: Under ideal conditions, all sensory systems work in concert therefore some redundancy exists. COP in conditions of increasing difficulty are measured. To determine the Stability Index, the visual and/or somatosensory... more
<p>Note: Under ideal conditions, all sensory systems work in concert therefore some redundancy exists. COP in conditions of increasing difficulty are measured. To determine the Stability Index, the visual and/or somatosensory systems are experimentally disrupted to derive the relative contribution of each system, however, the vestibular system is never experimentally disrupted. This protocol has been validated and has been used consistently for clinical assessment.</p><p>Stability Index Formula and Description.</p
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<p>Participant Flow Chart.</p
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BackgroundThe use of yoga as a therapeutic modality is increasing; however, a lack of transparent intervention reporting is restricting the dissemination and implementation of yoga research into clinical and community practice. The aim of... more
BackgroundThe use of yoga as a therapeutic modality is increasing; however, a lack of transparent intervention reporting is restricting the dissemination and implementation of yoga research into clinical and community practice. The aim of this study was to develop a yoga-specific reporting guideline as an extension to existing reporting guidelines for randomised controlled trials, observational studies and case reports.MethodsRecognised international stakeholders in the design and conduct of yoga research were invited to contribute to the electronic Delphi survey. A four-round Delphi was conducted, whereby panellists rated selected items for their importance in the inclusion of yoga reporting guidelines, according to a 5-step Likert scale. A priori consensus for item inclusion was agreement of items as ‘Very important’ or ‘Extremely important’ by ≥80% of panellists. Non-consensus items were forwarded to subsequent rounds for re-rating.Results53 experts in yoga research from 11 count...
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☯ These authors contributed equally to this work. ‡ These authors also contributed equally to this work.
Introduction: Chronic pain and the current opioid epidemic are pressing public health concerns, especially in low-income and ethnically diverse communities. Nonpharmacologic therapies that are safe, effective, and acceptable for the... more
Introduction: Chronic pain and the current opioid epidemic are pressing public health concerns, especially in low-income and ethnically diverse communities. Nonpharmacologic therapies that are safe, effective, and acceptable for the treatment of chronic pain conditions may provide a solution for addressing this issue. This qualitative analysis explores the experience of study participants who received combined acupuncture and yoga therapy (YT) to treat chronic pain delivered in a primary care setting. Methods: The group acupuncture with yoga therapy for chronic neck, low back, and osteoarthritic pain trial (GAPYOGA) assessed the feasibility and effectiveness of group acupuncture (GA) combined with YT in a low-income, racial, and ethnically diverse population. Individual in-depth interviews were conducted with a subset of patients in the trial. Nineteen participants were interviewed for qualitative analysis of their experience. Using the immersion and crystallization method, transcribed interviews were analyzed for themes meaningfully representing participant experience. Results: The combined GA and YT resulted in significant pain relief and transformative healing experiences. Three themes emerged from participant narratives: (1) transformative engagement with self in the healing process through pain relief, psychological well-being, and self-efficacy; (2) therapeutic relationship with acupuncture and yoga providers; and (3) fostering relationships with fellow participants in the group. Discussion: In this study of a low-income and ethnically diverse population, the combination of acupuncture and YT was found to alleviate pain, improve function, promote psychological well-being, and engage participants in self-care practices in a transformative healing process-resulting in physical and psychological benefits.
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Chronic pain is prevalent in the United States, with impact on physical and psychological functioning as well as lost work productivity. Minority and lower socioeconomic populations have increased prevalence of chronic pain with less... more
Chronic pain is prevalent in the United States, with impact on physical and psychological functioning as well as lost work productivity. Minority and lower socioeconomic populations have increased prevalence of chronic pain with less access to pain care, poorer outcomes, and higher risk of fatal opioid overdose. Acupuncture therapy is effective in treating chronic pain conditions including chronic low back pain, neck pain, shoulder pain, and knee pain from osteoarthritis. Acupuncture therapy, including group acupuncture, is feasible and effective, and specifically so for underserved and diverse populations at risk for health outcome disparities. Acupuncture therapy also encourages patient engagement and activation. As chronic pain improves, there is a natural progression to want and need to increase activity and movement recovery. Diverse movement approaches are important for improving range of motion, maintaining gains, strengthening, and promoting patient engagement and activation...
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Research Interests: Psychology and Medicine
Context • Yoga Therapy is an emerging complementary and integrative health practice for which there is increasing interest from both clinical and research perspectives. Currently missing, however, is an explanatory framework for the... more
Context • Yoga Therapy is an emerging complementary and integrative health practice for which there is increasing interest from both clinical and research perspectives. Currently missing, however, is an explanatory framework for the profession that provides practitioners, clients, and the public with an understanding of how various yogic traditions and principles can be understood in modern health care contexts. Objective • This study proposes an explanatory framework for yoga therapy, informed by phenomenology, eudaimonia, virtue ethics, and first-person ethical inquiry. Conclusions • These 4 philosophical perspectives-phenomenology, eudaimonia, virtue ethics, and first-person ethical inquiry-provide a lens through which to understand how yogic practices support the individual's transformation in the experience of illness, pain, or disability. We propose that this transformation occurs through facilitating a reharmonization of body, mind, and environment toward the experience o...
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BackgroundReporting of yoga research often lacks the detail required for clinical application, study replication, summary research and comparative effectiveness studies.MethodsTo improve the transparency of reporting yoga interventions,... more
BackgroundReporting of yoga research often lacks the detail required for clinical application, study replication, summary research and comparative effectiveness studies.MethodsTo improve the transparency of reporting yoga interventions, and building on the development of previous reporting guidelines, a group of international yoga research stakeholders developed the consensus-based CheckList stAndardising the Reporting of Interventions For Yoga (CLARIFY) guidelines.ResultsThe 21-item CLARIFY checklist outlines the minimum details considered necessary for high-quality reporting of yoga research. This paper provides a detailed explanation of each of the 21 items of the CLARIFY checklist, together with model examples of how to integrate each item into publications of yoga research. The CLARIFY guideline serves as an extension for existing research reporting guidelines, and is flexible for use across all study designs.ConclusionWe strongly encourage the uptake of these reporting guideli...
Research Interests: Medicine, Delphi, Psychological Intervention, Checklist, Alternative Medicine, and 7 moreDelphi method, BMJ, Elaboration, C, B, A, and GuideLine
Objective—To evaluate the impact of Integral-based hatha yoga in sedentary people with arthritis.Methods—75 sedentary adults aged 18+ with rheumatoid arthritis (RA) or knee osteoarthritis (OA) were randomly assigned to 8 weeks of yoga (2... more
Objective—To evaluate the impact of Integral-based hatha yoga in sedentary people with arthritis.Methods—75 sedentary adults aged 18+ with rheumatoid arthritis (RA) or knee osteoarthritis (OA) were randomly assigned to 8 weeks of yoga (2 60 min classes and 1 home practice/wk) or waitlist. Poses were modified for individual needs. The primary endpoint was physical health (SF36 Physical Component Summary [PCS]) adjusted for baseline; exploratory adjusted outcomes included fitness, mood, stress, self-efficacy, SF36 health-related quality of life (HRQL) and RA disease activity. In everyone completing yoga, we explored long-term effects at 9 months.Results—Participants were mostly female (96%), white (55%), and college-educated (51%), with a mean (SD) age of 52 (12). Average disease duration was 9 (9) yrs. and 49% had RA. At 8 weeks, yoga was associated with significantly higher PCS (6.5; 95% CI: 2.0,10.7), walking capacity (125 m; 95% CI:15,235), positive affect (5.2; 95% CI:1.4,8.9) an...
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There is growing evidence that yoga can be beneficial as an aspect of self-care for people with arthritis. However, yoga may be less acceptable to those from different cultures, socioeconomic backgrounds, and racial/ethnic identities.... more
There is growing evidence that yoga can be beneficial as an aspect of self-care for people with arthritis. However, yoga may be less acceptable to those from different cultures, socioeconomic backgrounds, and racial/ethnic identities. While implementing a feasibility/acceptability pilot study of yoga as self-care in minority communities, the subject of spirituality surfaced. This commentary shares the experience of the researchers and yoga teachers collaborating on the study and the larger conversation that ensued following the withdrawal of one of the study participants. It is an attempt to start a relevant and needed dialogue around yoga research as an integrative health modality, and why the underlying body-mind-spirit approach to yoga may sometimes serve as a barrier to participation for diverse populations suffering from arthritis.
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Yoga research is growing rapidly in volume and rigor but varies in sample size, study design, and reporting transparency. Yoga professionals may not be versed in the current research due to a lack of research literacy and may not be well... more
Yoga research is growing rapidly in volume and rigor but varies in sample size, study design, and reporting transparency. Yoga professionals may not be versed in the current research due to a lack of research literacy and may not be well positioned to discern research relevance and quality. Research literacy is necessary to apply research in yoga teaching and therapeutics. Research is part of evidence-informed practice, along with clinical experience and client preferences, and is aligned with concepts from yoga philosophy. Several strategies are available to improve research literacy and evidence-informed practice for yoga professionals, which can help to expand inter-professional collaboration and inform the trajectory of yoga research toward better alignment and application to clinical practice. Yoga research reporting guidelines will improve transparency in research dissemination for application to practice, policy, replication, comparison, and summarization.
Research Interests: Medicine and IGI Global
Yoga is a promising therapeutic modality for neurodegenerative diseases. This case study presents a therapeutic yoga protocol for adrenomyeloneuropathy (AMN) and its effect on a patient's quality of life (QOL), agility, balance, and... more
Yoga is a promising therapeutic modality for neurodegenerative diseases. This case study presents a therapeutic yoga protocol for adrenomyeloneuropathy (AMN) and its effect on a patient's quality of life (QOL), agility, balance, and peripheral dexterity. A 61-y-old man diagnosed with AMN who was experiencing (1) peripheral neuropathy in his legs and feet, (2) lower-back pain (LBP), and (3) osteoarthritis received 60-min weekly therapeutic yoga sessions for a 10-mo period. Yoga therapy included hatha yoga asanas (poses) and pranayama (breathing exercises). Hatha yoga asanas were aligned with 7 Berg Balance Scale (BBS) indicators to measure improvement in balance and range of motion. The 10-mo course of therapeutic yoga resulted in improved LBP; improved flexion of the patient's hips, knees, and ankles; improved propulsion phase of walking; and improvement in the patient's ability to stand and balance without an assistive device. The effect of yoga therapy on the patient i...
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OBJECTIVE To describe the personal, professional, practice, service and consumer characteristics of the North American yoga therapy workforce. DESIGN Cross-sectional, descriptive survey developed and informed by the contemporary workforce... more
OBJECTIVE To describe the personal, professional, practice, service and consumer characteristics of the North American yoga therapy workforce. DESIGN Cross-sectional, descriptive survey developed and informed by the contemporary workforce literature. A link to the e-survey was distributed to members of the International Association of Yoga Therapists. RESULTS 367 members responded (∼20% of eligible participants). Most were aged 40-69 years (88%) and female (91%). Almost half (42%) identified as a "seasoned yoga therapist" and few (9%) graduated from an accredited 800-h yoga therapy program. An average of 8h/week was spent in clinical practice with many (41%) earning an annual income of <US$10,000 from yoga therapy. Practice was informed by twenty different styles of yoga. Urban (39%) and suburban (38.1%) regions were the most common locations of practice. Most therapists conducted therapeutic yoga classes (91%) and 1:1 sessions (94%), with more than half delivering 1-10...
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Yoga therapy is an emerging profession with recent development of educational competencies, training program accreditation, and practitioner certification. In the United States, most yoga therapy training programs are studio-based and... more
Yoga therapy is an emerging profession with recent development of educational competencies, training program accreditation, and practitioner certification. In the United States, most yoga therapy training programs are studio-based and data on mentored clinical encounters are lacking. This study aimed to characterize the client population in a university-based mentored student clinic. As part of a larger feasibility study, data were collected at all clinic visits for 70 consenting clients. Data collected included demographic characteristics, reasons for pursuing care, use of other healthcare approaches, and the Patient-Reported Outcomes Measurement Information System (PROMIS) for physical and mental health. Participants were mostly middle-aged, White, and highly educated. Common reasons for pursuing care were pain and mental health. Most used multiple healthcare approaches. Average scores for most patient-reported outcomes fell within normal range at baseline. Future studies are need...
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Evidence-Informed Practice (EIP) utilizes the three components of expert opinion, research evidence, and client values. It is a recommended training competency for integrative health practitioners in diverse fields, such as acupuncture... more
Evidence-Informed Practice (EIP) utilizes the three components of expert opinion, research evidence, and client values. It is a recommended training competency for integrative health practitioners in diverse fields, such as acupuncture and massage therapy. Research Literacy (RL) is a necessary pre-requisite to EIP. Many yoga therapists have limited training in these skills, which negatively impacts inter-professional communication and collaboration, as well as further advancement of yoga therapy research and practice. In this article, we propose inclusion of RL and EIP in the training of yoga therapists. Benefits for client care, collaborative care, and the field of yoga therapy are discussed.
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While there is a growing interest in the therapeutic benefits of yoga, minority populations with arthritis tend to be under-represented in the research. Additionally, there is an absence of guidance in the literature regarding the use of... more
While there is a growing interest in the therapeutic benefits of yoga, minority populations with arthritis tend to be under-represented in the research. Additionally, there is an absence of guidance in the literature regarding the use of multicultural teams and sociocultural health beliefs, when designing yoga studies for a racially diverse population with arthritis. This pilot study examined the feasibility of offering yoga as a self-care modality to an urban, bilingual, minority population with osteoarthritis (OA) or rheumatoid arthritis (RA), in the Washington, DC area. The primary objective of the study was to assess the feasibility of offering an 8-week, bilingual yoga intervention adapted for arthritis to a convenience sample of primarily Hispanic and Black/African-American adults. A racially diverse interdisciplinary research team was assembled to design a study to facilitate recruitment and retention. The second objective identified outcome measures to operationalize potenti...
Evidence-Informed Practice (EIP) utilizes the three components of expert opinion, research evidence, and client values. It is a recommended training competency for integra-tive health practitioners in diverse fields, such as acupuncture... more
Evidence-Informed Practice (EIP) utilizes the three components of expert opinion, research evidence, and client values. It is a recommended training competency for integra-tive health practitioners in diverse fields, such as acupuncture and massage therapy. Research Literacy (RL) is a necessary prerequisite to EIP. Many yoga therapists have limited training in these skills, which negatively impacts inter-professional communication and collaboration, as well as further advancement of yoga therapy research and practice. In this article, we propose inclusion of RL and EIP in the training of yoga therapists. Benefits for client care, collabo-rative care, and the field of yoga therapy are discussed.
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Background. Arthritis is a chronic, painful disease affecting 26 million Americans. It is the leading cause of disability and is associated with joint destruction, loss of function, deformity, depression and poor quality of life (QOL).... more
Background. Arthritis is a chronic, painful disease affecting 26 million Americans. It is the leading cause of disability and is associated with joint destruction, loss of function, deformity, depression and poor quality of life (QOL). Physical activity is recommended for comprehensive arthritis management. Unfortunately, most individuals who start an exercise program do not continue. Yoga is an ancient Indian practice that combines physical activity with deep breathing, relaxation and meditation. By addressing physical and psychological aspects of health, it may be beneficial for arthritis patients and contribute to greater QOL. Methods. A randomized controlled trial is underway to determine the effects of an 8-week modified yoga program on QOL for sedentary adults with arthritis. The intervention includes 2 weekly yoga sessions and one hour of home practice. The control group is a waitlist with usual care. QOL is measured using the SF-36 before, during and after the intervention, ...
BACKGROUND: Rheumatoid arthritis (RA) is a disabling systemic disease with no cure. Yoga, currently considered to be a complementary and alternative medicine modality under investigation for potential health benefits, is an ancient... more
BACKGROUND: Rheumatoid arthritis (RA) is a disabling systemic disease with no cure. Yoga, currently considered to be a complementary and alternative medicine modality under investigation for potential health benefits, is an ancient physical activity that shows promise for slowing RA disability and helping to manage symptoms. METHOD: Participants were 30 sedentary adults with RA and randomly assigned to an 8 week yoga program or a waitlist control group. Joint assessments were done by experienced clinic assessors who were blinded to treatment group. RESULTS: Participants had a mean age of 46.0 12.0 yrs, and were mostly female (97%) and Caucasian (67%) with mean disease duration of 8.0 7.7 years. At baseline, participants had a mean of 6.8 6.8 tender joints and 6.5 5.8 swollen joints. No significant differences were found in age, race, sex, education or RA disease characteristics between groups. As compared to baseline, participants who completed the yoga program, participants had few...
Yoga is a promising therapeutic modality for neurodegenerative diseases. This case study presents a therapeutic yoga protocol for adrenomyeloneuropathy (AMN) and its effect on a patient's quality of life (QOL), agility, balance, and... more
Yoga is a promising therapeutic modality for neurodegenerative diseases. This case study presents a therapeutic yoga protocol for adrenomyeloneuropathy (AMN) and its effect on a patient's quality of life (QOL), agility, balance, and peripheral dexterity. A 61-y-old man diagnosed with AMN who was experiencing (1) peripheral neuropathy in his legs and feet, (2) lower-back pain (LBP), and (3) osteoarthritis received 60-min weekly therapeutic yoga sessions for a 10-mo period. Yoga therapy included hatha yoga asanas (poses) and pranayama (breathing exercises). Hatha yoga asanas were aligned with 7 Berg Balance Scale (BBS) indicators to measure improvement in balance and range of motion. The 10-mo course of therapeutic yoga resulted in improved LBP; improved flexion of the patient's hips, knees, and ankles; improved propulsion phase of walking; and improvement in the patient's ability to stand and balance without an assistive device. The effect of yoga therapy on the patient i...
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ABSTRACT Rheumatoid arthritis (RA) is a chronic, painful disease resulting in disability, difficulty with activities and poor quality of life (QOL). Exercise is recommended to reduce symptoms, slow progression and decrease muscle wasting.... more
ABSTRACT Rheumatoid arthritis (RA) is a chronic, painful disease resulting in disability, difficulty with activities and poor quality of life (QOL). Exercise is recommended to reduce symptoms, slow progression and decrease muscle wasting. Unfortunately, most RA patients are sedentary. Yoga is an ancient Indian form including physical poses, deep breathing, relaxation and meditation, which may benefit RA patients. This is a small RCT (N=40) of an 8-week yoga intervention. Inclusion criteria are: age 18 or older, RA diagnosis, sedentary but able to exercise, stable disease for 6 months, no use of assistive devices for walking, and no co-morbid conditions with similar symptoms. Participants are randomized to immediate treatment or waitlist control. The intervention includes 2 hour-long classes per week and one hour of home practice. Outcomes are measured at baseline, midpoint, end of classes and 6 months later. These include QOL, physical fitness, psychological wellbeing and disease activity. Baseline data is available for 31 patients. Eleven have completed intervention (6) or control (5). At baseline, RA patients had lower QOL than healthy norms, especially for physical domains. After 8 weeks of yoga, the intervention group improved on all impaired domains, compared to controls (p&lt;.05). Other outcomes have not yet been assessed. Although this data is based only on the first cohort, yoga shows promise for improving QOL in patients with RA. Further investigation is necessary to determine the sustainability of these benefits.
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Research Interests: Obesity, Quality Control, Safety, Overweight, Humans, and 5 moreWeight Loss, Animals, Dietary Supplements, Alkaloids, and Citrus
ABSTRACT Objective: To test the effects of a lifestyle physical activity [LPA] program on health status, pain, fatigue, and function in adults with the fibromyalgia syndrome [FMS]. Methods: Forty-eight sedentary adults with FMS were... more
ABSTRACT Objective: To test the effects of a lifestyle physical activity [LPA] program on health status, pain, fatigue, and function in adults with the fibromyalgia syndrome [FMS]. Methods: Forty-eight sedentary adults with FMS were randomized to either LPA or a FMS education control [FME] group. The LPA participants gradually worked toward accumulating 30 minutes of self-selected moderate-intensity LPA, five to seven days per week. Thirty-four participants [71 percent] completed the study. Results: The LPA group increased their physical activity by 70 percent, as assessed by pedometer. Seventy-one percent of participants randomized to LPA reported that their health status was improved, compared with 25 percent of the FME group [P = 0.013]. There were no statistically significant post-intervention differences between the LPA and FME groups in pain, fatigue, FMS impact, or six-minute walk distance. Conclusion: The LPA group increased their physical activity and improved global ratings of FMS-related change. Lifestyle physical activity might be a new way to assist persons with FMS to become more physically active.
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Obesity is a risk factor for the development and progression of arthritis. Weight loss can provide symptomatic benefit for adults with arthritis. To describe the proportion and characteristics of adults with self-reported diagnosed... more
Obesity is a risk factor for the development and progression of arthritis. Weight loss can provide symptomatic benefit for adults with arthritis. To describe the proportion and characteristics of adults with self-reported diagnosed arthritis who report ever having been advised by a doctor or health professional that losing weight might benefit their arthritis or joint symptoms and to assess whether receiving the advice was associated with trying to lose weight. Using population-based survey data from the 2005 Behavioral Risk Factor Surveillance Survey (BRFSS), we classified respondents according to their arthritis status, gender, ethnicity, age, education, body mass index, activity limitations due to joint symptoms, whether or not they received advice to lose weight from a doctor or health professionals, and whether they report trying to lose weight. Less than half (45.7%) of overweight or obese respondents with arthritis reported ever being advised by a doctor or health professional that losing weight might help their arthritis or joint symptoms. Respondents who were more likely to have received the advice were female, older, obese, with higher levels of education, and reported activity limitations due to joint symptoms. Overweight and obese respondents who reported receiving advice to lose weight were significantly more likely to report trying to lose weight than those who did not receive advice (odds ratio [OR] = 3.75; 95% confidence interval [95% CI] = 3.39-4.15). Receiving advice was associated with a greater likelihood of trying to lose weight. Health care professionals should advise overweight and obese adults with arthritis about the potential benefits of weight loss and should provide the resources to assist these patients in losing weight.