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Evidence-Based Complementary and Alternative Medicine
Volume 2013, Article ID 130818, 11 pages
http://dx.doi.org/10.1155/2013/130818
Research Article

Mediators of Yoga and Stretching for Chronic Low Back Pain

1Group Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA 98101, USA
2Department of Epidemiology, University of Washington, Seattle, WA 98101, USA
3Department of Biostatistics, University of Washington, Seattle, WA 98101, USA
4Departments of Family Medicine and Health Services, University of Washington, Seattle, WA 98101, USA
5Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, Seattle, WA 98109, USA

Received 9 January 2013; Accepted 14 March 2013

Academic Editor: David Baxter

Copyright © 2013 Karen J. Sherman et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Although yoga is an effective treatment for chronic low back pain, little is known about the mechanisms responsible for its benefits. In a trial comparing yoga to intensive stretching and self-care, we explored whether physical (hours of back exercise/week), cognitive (fear avoidance, body awareness, and self-efficacy), affective (psychological distress, perceived stress, positive states of mind, and sleep), and physiological factors (cortisol, DHEA) mediated the effects of yoga or stretching on back-related dysfunction (Roland-Morris Disability Scale (RDQ)). For yoga, 36% of the effect on 12-week RDQ was mediated by increased self-efficacy, 18% by sleep disturbance, 9% by hours of back exercise, and 61% by the best combination of all possible mediators (6 mediators). For stretching, 23% of the effect was mediated by increased self-efficacy, 14% by days of back exercise, and 50% by the best combination of all possible mediators (7 mediators). In open-ended questions, ≥20% of participants noted the following treatment benefits: learning new exercises (both groups), relaxation, increased awareness, and the benefits of breathing (yoga), benefits of regular practice (stretching). Although both self-efficacy and hours of back exercise were the strongest mediators for each intervention, compared to self-care, qualitative data suggest that they may exert their benefits through partially distinct mechanisms.