Fernanda Mazzoni da Costa1; Rosangela Maria Greco2; Neusa Maria Costa Alexandre3
BACKGROUND: Effects of yoga on physical and mental health have been investigated in several fields.
OBJECTIVE: To investigate and analyze results of yoga interventions in the workplace reported along 10 years after the formulation of the National Policy of Integrative and Complementary Practices.
METHOD: We located 10 studies published from 2006 to 2015 which met the inclusion criteria, included in databases Cumulative Index of Nursing and Allied Health Literature (CINAHL), Medical Literature Analyses and Retrieval System Online (MEDLINE), Web of Science, Scopus, Cochrane and Scientific Electronic Library Online (SciELO). Analyzed variables were: publication year, authorship, title, aims, results, and conclusions. Interventions were characterized based on yoga style, practices implemented, frequency and duration of sessions, duration of intervention, measurement instruments, and additional interventions.
RESULTS: Our findings suggest that yoga has physical and psychological effects on workers from different professional categories. However, we did not find benefits for some conditions, and yoga practice does not have the same positive effects on all practitioners. Workers' adherence to programs influences the results of research. Many studies did not clearly describe the implemented programs.
CONCLUSION: The characteristics of interventions show substantial differences among programs, which enable a synthesis, but not comparisons.
Keywords: occupational health; complementary therapies; yoga; review.
INTRODUÇÃO: Efeitos do ioga no bem-estar físico e mental têm sido estudados em diversas áreas.
OBJETIVOS: Investigar e analisar o que a literatura científica dos dez anos subsequentes à publicação da Política Nacional de Práticas Integrativas e Complementares apresenta sobre resultados de intervenções utilizando ioga no ambiente de trabalho com trabalhadores.
MÉTODO: Foram encontrados 10 artigos que se enquadraram nos critérios de inclusão, publicados de 2006 a 2015, disponíveis nas bases Cumulative Index of Nursing and Allied Health Literature (CINAHL), Medical Literature Analyses and Retrieval System Online (MedLine), Web of Science, Scopus, Cochrane e Scientific Electronic Library Online (SciELO). Os artigos foram analisados quanto a ano de publicação, autoria, título, objetivos, resultados, conclusões e as intervenções caracterizadas quanto ao tipo de ioga, práticas envolvidas, frequência, duração da prática e da intervenção, instrumentos de medida e intervenções adicionais.
RESULTADOS: Os achados sugerem que o ioga está relacionado a efeitos físicos e psicológicos em trabalhadores de diferentes áreas, mas não foram encontrados benefícios sobre determinadas condições e a prática não proporciona o mesmo efeito positivo para todos. Verificou-se que a adesão dos trabalhadores aos programas propostos influencia os resultados das investigações. Muitos dos estudos não descreveram com clareza os programas.
CONCLUSÃO: As características descritas evidenciam programas diferentes, permitindo uma síntese dos resultados, mas não uma comparação entre eles.
Palavras-chave: saúde do trabalhador; terapias complementares; ioga; revisão.
Work is a means to meet economic needs and ensure the social inclusion of individuals. However, as a function of the conditions under which it is performed, work might also be a cause of physical and mental illness, and bring suffering to workers and the people close to them.
The conditions under which work is performed influence the quality of the resulting products, therefore they have also impact on consumers. Work–related diseases might reduce productivity, cause absenteeism, sick leave, restrictions to activities, and need for compensation. How organizations treat their employees reflects on customers and communication means, projects on their public image, and interferes with the obtainment of the necessary material and human resources. All these issues have economic and social impacts for companies1.
Illness among the economically active population affects the national economy and the social security administration, as well the health system as a function of the cost of health care and the possible violation of the fundamental right to health set as goal in the Brazilian Health Reform2, formalized at the 8th National Health Conference3, defined in the 1988 Federal Constitution, and established in the Organic Law on Health4.
Promotion of the physical and mental health of workers is relevant for employers, which have sought to accomplish this goal through institutional mechanisms, and also for the government, which is incentivizing and regulating such actions. This is the context for the National Policy of Safety and Health at Work which aims are to promote health, improve the quality of life of workers, and prevent work–related accidents and health problems5.
Actions for prevention, health promotion, maintenance and recovery might be considered from different theoretical and practical perspectives. Grounded on political, technical, economic, social and cultural reasons, in 2006 the Ministry of Health formulated the National Policy of Integrative and Complementary Practices (Política Nacional de Práticas Integrativas e Complementares — PNPIC) which seeks to ensure integral health care and strengthen the principles underlying the Unified Health System through a healthcare model centered on the uniqueness of each individual6.
Yoga is an integrative and complementary practice acknowledged as such by the World Health Organization (WHO)7 and PNPIC8.
While in recent decades it was reduced to a simplified psychophysical practice—which is awakening the interest of the scientific community, being used as therapeutic option in several fields, and its effects are increasingly legitimized by the population—classic yoga is a millenary complex system. Originated in the Vedic tradition, initially transmitted from master to disciple (Parampara) and then recovered and systematized by Patañjali, yoga comprises eight techniques (Asthanga) which should be gradually practiced, to wit: an ethical–philosophical doctrine of restraints or abstentions (yama) and positive duties or observances (niyama), body postures (asanas), control of the vital energy through breathing (pranayama), control of sensory perceptions (pratyahara), concentration (dharana), meditation (dhyana) and control over mind (samadhi). Practice allegedly reduces the agitation of mind, which provides the conditions for Yoga, i.e. the perception of one's one essence and connection with creative energy9.
Therefore, yoga is originally a method for self-accomplishment based on a series of techniques, which therapeutic benefits are seen as a mere means to provide the conditions needed to accomplish the ultimate goal, and not as an end in themselves. In turn, that which eventually came to be generically known as yoga is just the practice of some such techniques. In any case, according to the WHO several studies demonstrated the benefits of yoga practice in terms of physical and mental well-being10, and the practical and psychological integration promoted by the yoga philosophy is seen as a valuable tool for human development and management11.
Based on the aforementioned considerations, the aim of the present study was to investigate and analyze the scientific literature on the results of yoga interventions in the workplace published along ten years after the formulation of PNPIC. Literature reviews allow analyzing and synthesizing the results of different studies, and thus enable the application of the evidence reported in scientific studies into practice12.
We performed an integrative literature review, namely, a method to survey and synthesize studies on a given subject to provide a broad scoped view of the state of the art and discuss its applicability13,14.
For this purpose, we followed the following steps: formulation of the research question, literature survey, data collection, critical analysis of the included studies, discussion of results, and presentation of the integrative review15.
The research question was: what the scientific literature published along ten years after the formulation of PNPIC reports on the results of yoga interventions in the workplace?
We searched for national and international studies published from 2006 to 2015 in databases Cumulative Index of Nursing and Allied Health Literature (CINAHL), Medical Literature Analyses and Retrieval System Online (MEDLINE), Web of Science, Scopus, Cochrane, Latin American and Caribbean Health Sciences Literature (Literatura Latino-americana e do Caribe em Ciências da Saúde—LILACS) and Scientific Electronic Library Online (SciELO) using combination "yoga" and "occupational health" and corresponding expressions in Spanish—"salud laboral"—and Portuguese—"saúde occupational." After removing duplicates, we performed a preliminary analysis which resulted in the exclusion of all the studies which had not been published as journal articles, were unfinished or without full text available in English, Portuguese or Spanish. The remaining studies were analyzed, and the ones corresponding to intervention studies and which described the results of classic yoga within occupational health settings were included for review.
Using instruments which ensure that all relevant information will be extracted, reduce the risk of transcription errors, warrant the accuracy of the data, and serve as record is relevant in the step of data collection15. For this reason we drew a table for data collection and organization based on an instrument developed and validated for use in integrative reviews12, which includes the following information: year of publication, authors, title, aims, results and recommendations / suggestions.
This table grounded the initial analysis of the following data: year of publication, authors, aims, results and conclusions. We then drew a second table with information on the characteristics of interventions, including: yoga style, practices implemented, frequency and duration of sessions, duration of intervention, measurement instruments, and additional interventions.
Based on the interpretation and synthesis of the results and reference literature, we discussed the data, detected gaps, and defined priorities for future studies.
Finally, we prepared the presentation of the review, which enabled comparisons of convergences and divergences between the selected studies, and the identification of trends in the study of the subject of interest.
We initially located 100 studies, being 22 in database CINAHL, 18 in MEDLINE, 17 in Web of Science, 27 in Scopus, 7 in Cochrane and 9 in SciELO; no study meeting the search criteria was located in LILACS.
Sixty-five studies remained after removal of duplicates, 19 of which were excluded on the preliminary analysis (17 were not journal articles, one was not finished, and the full text of one was available in Japanese only). For the remaining 46 studies, analysis showed that 36 did not answer the research question (nine did not address classic yoga, 12 did not deal with occupational health, and 15 did not assess the results of yoga interventions). Therefore, 10 studies were included for review, as shown in Figure 1.
Variables publication year, authors, title, aims, results and recommendations / conclusions are described in Chart 1 according to publication year.
Chart 2 describes the characterization of the interventions performed in the analyzed studies.
As Chart 2 shows, two studies were published in 2009, one in 2010, two in 2011, two in 2012, one in 2013, one in 2014, and one in 2015. Four studies were conducted in the United States, two in Japan, two in the Netherlands (relative to one and the same intervention), one in India, and one in Brazil.
The studies analyzed specific populations, to wit: musicians, professional computer users, firefighters, university employees, university hospital employees, child–care female workers, and school employees.
Nine of the ten included studies reported favorable results of yoga practice among the analyzed populations; five for all the assessed outcomes16-20, and four for some outcomes21-24, while the results of one study did not evidence benefits of yoga for any analyzed outcome25.
The studies which found benefits of yoga practice reported reduction of symptoms and undesirable health conditions, and increase of desirable conditions, with impact on the performance of physical, functional, professional and social activities21.
Such studies reported improvements in physical health aspects (flexibility17,18,22, breathing pattern17, sleep16,19, weight loss, body fat percentage, and diastolic blood pressure22), pain (menstrual16, musculoskeletal16,17), psychosocial aspects (physical symptoms19, stress17, anxiety16,19,24, tension, depression, irritability24, social dysfunction19, concentration, resistance and balance17, comfort19, calmness17,19, cheerfulness19,20, clear-mindedness, quietness, energy, confidence, life purpose, satisfaction, self-confidence in stressful situations20, feeling of well-being21), quality of life22, self-care, (adoption of healthy habits, such as weekly sports practice and fruit intake23) and job performance (interference by musculoskeletal symptoms18, need to recover after the work day23, increased hand grip strength and typing speed18, and functional fitness17).
In one study, musculoskeletal discomfort increased and the typing speed decreased in the group that did not receive yoga intervention18.
Some studies did not find benefits of yoga for some outcomes, such as musculoskeletal symptoms, stress or sleep24, and mental health23. Other studies did not find statistically significant difference in the systolic blood pressure22, ability to perform vigorous–intensity physical activity or aerobic capacity23. One study found that yoga practice did not have the same positive effects on all the participants21.
One study that analyzed vitality, work engagement, productivity and sick leaves did not find evidence for the efficacy of yoga in any of the analyzed outcomes25.
Low adherence of workers to the indicated intervention programs might interfere with the results of studies26. More expressive results were reported for the higher compliance groups16,25. In one study the participants stated that the results would have been better were them to have had practiced yoga more often17. These findings suggest that the results depend on the frequency of sessions and strategies to promote adherence among workers.
Aware of the relevance of adherence, a study analyzed how a health promotion program for hospital employees was developed, for which purpose the authors analyzed factors such as context, fidelity, reach, dose delivered, dose received, and participants' attitude. The results showed that taken all the components of intervention together, the reach was just 52%. The authors attributed such low adherence rate to the distance from workplace to the workout sessions, the fact that sessions were provided during lunchtime and after working hours, and that the participants had not been included in the planning of actions; as consequence, they made suggestions to overcome such shortcomings27.
Another study described a partnership between a nursing school and a nursing service management to adopt yoga as model for a health and occupational well-being program for nurses, and discussed recommendations to ensure the program sustainability over time. The school contributed with the program implementation and research, and the hospital nursing service management with its expertise on communication channels and institutional culture. The authors observed that to ensure their sustainability, well-being programs should include continuous management infrastructure, identification of key–links for implementation, and verification of the main indicators to provide the higher management evidence of the cost-effectiveness benefit of implementation, thus justifying the corresponding financial investment28.
Chart 2 further shows that several studies did not clearly describe the characteristics of the tested programs. In addition, when such characteristics were reported, they differed considerably in regard to yoga style, implemented practices, frequency and duration of sessions, duration of intervention, measurement instruments and concomitant additional interventions. For this reason, a synthesis of the results was possible, but comparisons were not. Future studies might implement similar programs so as to enable comparisons.
Similarly, a study which sought the analyze scientific studies on the efficacy of yoga for management of chronic unspecific low back pain among workers found that the number of such studies was small, most had a small sample size, and variable duration of intervention, thus hindering comparisons. The authors observed that although there were hints indicating that yoga might serve as a therapeutic option, additional research is needed to formulate definitive recommendations29.
The results of the present review indicate that yoga practice is associated with favorable physical and psychological effects among workers from different professional categories. Therefore it emerges as an integrative and complementary practice that might be adopted in occupational health settings. In addition, results are more satisfactory when strategies to promote the participation of workers are implemented.
However, the analyzed studies described programs with different characteristics, and thus we were able to synthesize, but not to compare the results. This situation points to the need for additional studies to implement similar programs to enable analysis leading to sound conclusions on the best methods to be used.
1. Duarte NS, Mauro MYC. Análise dos fatores de riscos ocupacionais do trabalho de enfermagem sob a ótica dos enfermeiros. RevBras Saúde Ocup. 2010;35(121):157-67. http://dx.doi.org/10.1590/S0303-76572010000100017
2. Brasil. Ministério da Saúde. 8ª Conferência Nacional da Saúde. Relatório final. Brasília: Ministério da Saúde; 1986.
3. Brasil. Presidência da República. Casa Civil. Constituição da República Federativa do Brasil. Brasília; 1988.
4. Brasil. Lei nº 8.080, de 19 de setembro de 1990. Dispõe sobre as condições para a promoção, proteção e recuperação da saúde, a organização e o funcionamento dos serviços correspondentes e dá outras providências. Diário Oficial da União. 1990.
5. Brasil. Decreto nº 7.602, de 7 de novembro de 2011. Dispõe sobre a Política Nacional de Segurança e Saúde no Trabalho - PNSST. Diário Oficial da União. 2011;1:9-10.
6. Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Política Nacional de Práticas Integrativas e Complementares no SUS - PNPIC-SUS. Brasília: Ministério da Saúde; 2006.
7. World Health Organization. WHO Traditional Medicine Strategy 2002-2005. Genebra: World Health Organization; 2002.
8. Brasil. Portaria nº 2.681, de 7 de novembro de 2013. Redefine o Programa Academia da Saúde no âmbito do Sistema Único de Saúde (SUS). Diário Oficial da União. 2013;1:37.
9. Martins RA. O ioga tradicional de Patañjali. O Raja-ioga Segundo o ioga-Sutra e outros textos indianos clássicos. São Paulo: Shri ioga Devi; 2012.
10. World Health Organization. Promoting Mental Health: concepts, emerging evidence, practice. Geneva: World Health Organization; 2005.
11. Asthana A, Asthana AN. Yogic Science for Human Resource Management in Business. World Appl Sci J. 2012;19(1):120-30. http://dx.doi.org/10.5829/idosi.wasj.2012.19.01.619
12. Ursi ES, Galvão CM. Prevenção de lesões de pele no perioperatório: revisão integrativa da literatura. Rev Latino-Am Enfermagem. 2006;14(1):124-31. http://dx.doi.org/10.1590/S0104-11692006000100017
13. Pompeo DA, Rossi LA, Galvão CM. Revisão integrativa: etapa inicial do processo de validação de diagnóstico de enfermagem. Acta Paul Enferm. 2009;22(4):434-8. http://dx.doi.org/10.1590/S0103-21002009000400014
14. Mendes KDS, Silveira RCCP, Galvão CM. Revisão integrativa: método de pesquisa para a incorporação de evidências na saúde e na enfermagem. Texto Contexto Enferm. 2008;17(4):758-64. http://dx.doi.org/10.1590/S0104-07072008000400018
15. Souza MT, Silva MD, Carvalho R. Revisão integrativa: o que é e como fazer. Einstein (São Paulo). 2010;8(1):102-6.
16. Sakuma Y, Sasaki-Otomaru A, Ishida S, Kanoya Y, Arakawa C, Mochizuki Y, et al. Effect of a home-based simple yoga program in child-care workers: a randomized controlled trial. J Altern Complement Med. 2012;18(8):769-76. https://doi.org/10.1089/acm.2011.0080
17. Cowen VS. Functional fitness improvements after a worksitebased yoga initiative. J Bodyw Mov Ther. 2010;14(1):50-4. https://doi.org/10.1016/j.jbmt.2009.02.006
18. Telles S, Dash M, Naveen KV. Effect of Yoga on musculoskeletal discomfort and motor functions in professional computer users. Work. 2009;33(3):297-306. https://doi.org/10.3233/WOR-2009-0877
19. Nosaka M, Okamura H. A single session of an integrated yoga program as a stress management toll for school employees: comparison of daily practice and nondaily practice of a yoga therapy program. J Altern Complement Med. 2015;21(7):444-9. https://doi.org/10.1089/acm.2014.0289
20. Hartfiel N, Havenhand J, Khalsa SB, Clarke G, Krayer A. The effectiveness of yoga for the improvement of well-being and resilience to stress in the workplace. Scand J Work Environ Health. 2011;37(1):70-6.
21. Barros NF, Siegel P, Moura SM, Cavalari TA, S i lva LG, Furlanetti MR, et al. Yoga e promoção da saúde. Ciênc Saúde Coletiva. 2014;19(4):1305-14. http://dx.doi.org/10.1590/1413-81232014194.01732013
22. Thomley BS, Ray SH, Cha SS, Bauer BA. Effects of a brief, comprehensive, yoga-based program on quality of life and biometric measures in an employee population: a pilot study. Explore (NY). 2011;7(1):27-9. https://doi.org/10.1016/j.explore.2010.10.004
23. Strijk JE, Proper KI, van der Beek AJ, van Mechelen W. A worksite vitality intervention to improve older workers' lifestyle and vitality - related outcomes: results of a randomised controlled trial. J Epidemiol Community Health. 2012;66(11):1071-8.
24. Khalsa SB, Shorter SM, Cope S, Wyshak G, Sklar E. Yoga ameliorates performance anxiety and mood disturbance in young professional musicians. Appl Psychophysiol Biofeedback. 2009;34(4):279-89. https://doi.org/10.1007/s10484-009-9103-4
25. Strijk JE, Proper KI, van Mechelen W, van der Beek AJ. Effectiveness of a worksite lifestyle intervention on vitality, work engagement, productivity, and sick leave: results of a randomized controlled trial. Scand J Work Environ Health. 2013;39(1):66-75. https://doi.org/10.5271/sjweh.3311
26. Van Dongen JM1, Strijk JE, Proper KI, van Wier MF, van Mechelen W, van Tulder MW, et al. A cost-effectiveness and return-oninvestment analysis of a worksite vitality intervention among older hospital workers: results of a randomized controlled trial. J Occup Environ Med. 2013;55(3):337-46. https://doi.org/10.1097/JOM.0b013e31827b738e
27. Strijk JE, Proper KI, van der Beek AJ, van Mechelen W. A process evaluation of a worksite vitality intervention among ageing hospital workers. Int J Behav Nutr Phys Act. 2011;8:58. https://doi.org/10.1186/1479-5868-8-58
28. Alexander G. Self-care and yoga academic-practice collaboration for occupational health. Workplace Health Saf. 2013;61(12):510-3. https://doi.org/10.1177/216507991306101202
29. Carter C, Stratton C, Mallory D. Yoga to treat nonspecific low back pain. AAOHN J. 2011;59(8):355-61. https://doi.org/10.3928/08910162-20110718-01
8 de Dezembro de 2017.
Aceito em 29 de Novembro de 2018.
Fonte de financiamento: Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)