Yoga's Effect on Oxidative Stress in Type 2 Diabetes Patients

This report presents a study investigating the impact of yoga on oxidative stress in elderly patients with type 2 diabetes. The literature review highlights the increasing prevalence of type 2 diabetes globally and the associated comorbidities. The research aims to evaluate the effectiveness of yoga in reducing oxidative stress, BMI, and blood pressure, as well as improving antioxidant potential. The study employs a quantitative research paradigm, conducted at yoga centers in Jordan, with participants divided into elderly and younger groups undergoing yoga intervention for one year. Measurements include blood glucose, BMI, blood pressure, and oxidative stress markers. The report discusses the yoga intervention protocol, statistical analysis methods, and expected outcomes, emphasizing the potential benefits for both patients and healthcare professionals. The conclusion suggests that yoga is a suitable, cost-effective intervention to improve oxidative stress and glycemic status in elderly type 2 diabetic patients. The study also proposes further research to optimize the duration and content of the yoga intervention.

Running Head: OXIDATIVE STRESS IN TYPE 2 DIABETIC PATIENT
Oxidative stress in type 2 diabetic patient
Name of the Student
Name of the University
Author Note

1OXIDATIVE STRESS IN TYPE 2 DIABETIC PATIENT
Table of Contents
Literature review..................................................................................................................2
Research questions...............................................................................................................3
Methods...............................................................................................................................4
Importance, relevance and impact.......................................................................................7
Conclusion...........................................................................................................................8
References............................................................................................................................9

2OXIDATIVE STRESS IN TYPE 2 DIABETIC PATIENT
Title- To evaluate the effect of yoga on elderly subjects with type 2 diabetes having
high oxidative stress
Literature review
There is a high prevalence of type 2 diabetes in Jordan, and the incidence of the illness is
increasing. Not only in Jordan but across the world there is an increasing prevalence of diabetes
(Cadier et al. 2017). As per the International Diabetes Federation reports in 2015 there were
more than 400 million people diagnosed with diabetes. According to the World Health Report,
90% of the people with diabetes have type 2 form. It caused an estimated 1.5 million deaths in
2012. The incidence of death is increasing in low and middle-income countries. It is estimated
the deaths due to type diabetes in the world may double by 2030 (World Health Organization
2016). The comorbidities associated with the illness such as heart diseases, hypertension,
amputations, mental health problems and skin issues, can be delayed or prevented. Therefore,
there is a need for preventive measure.
It is found in majority of cases that diabetes is associated with sedentary lifestyle. As per
the recent literature, the major risk factor of the type 2 diabetes is the lack of physical activity.
For obese individuals and overweight individuals weight loss is recommended. Physical
interventions like exercise and corresponding changes in weight result in fitness, improved
glycemic control, and offset of other complications type 2 diabetes mellitus and reduce the
cardiovascular risk factors (Mendham et al. 2015). Exercises like yoga appear to be beneficial in
the management of type 2 diabetes. As per the study by Chimkode et al. (2015), yoga is effective
in the patients with the type 2 diabetes, in reducing the blood glucose levels. Yoga is the
inexpensive lifestyle intervention that can be easily implemented as low cost strategy in the

3OXIDATIVE STRESS IN TYPE 2 DIABETIC PATIENT
developing country. It can be considered an economical adjuvant and a beneficial method to
manage type 2 diabetes. Yoga is the mind-body practice that includes breathing exercises,
meditation, and physical postures. It had been found to have a different effect on hypothalamus-
pituitary-adrenal response, and it has different effect on the sympathetic nervous system as well.
Few studies have reported that yoga can be useful mechanism to manage the oxidative stress and
blood glucose in type 2 diabetes (Muthuselvi et al. 2017).
Oxidative stress is associated with type 2 diabetes. Increased oxidative stress and ageing
are known to be a contributory factor of complications in type 2 diabetes mellitus (Stadler 2013).
Therefore the present study is focused on determining the effect of yoga on oxidative stress,
where the intervention will be tested for the changes in blood pressure, BMI, and the glycemic
status. The rationale for choosing this intervention is the cost effectiveness. It is an effective
method for the people having sedentary lifestyle as it will increase the effectiveness of the
diabetes treatment as evident from literature review that there are a lot of health benefits of
Yoga. However, there are few studies that determined the effect of yoga on the oxidative stress
in elder patients. The rationale for choosing the older patients with type 2 diabetes is the high
level of oxidative stress with ageing (Butterfield et al. 2014).
Research questions
 Is yoga effective therapy for reducing oxidative stress, BMI and blood pressure in
type 2 diabetes elderly patients?
 Is yoga beneficial for improving the antioxidant potential in the aged patients with
type 2 diabetes?

4OXIDATIVE STRESS IN TYPE 2 DIABETIC PATIENT
Methods
Setting
For achieving the aim of the study, a quantitative research paradigm is chosen. The study
is planned to conduct at two yoga centres of XYZ hospital in Jordan. The Urban hospital setting
is selected for conducting the study.
Participants
The participants for the study will be selected from the diabetes out-patient department of
the hospital. The study participants will be divided into two groups. In one group only elderly
patients with type 2 diabetes will be allocated, and another group will contain younger subjects.
The intervention includes delivering Yoga intervention to elderly diabetic patients as well as
younger subjects for one year. Both the groups will be subjected to the intervention for one year.
During the intervention, the subjects in both the groups will be allowed to have normal diet and
medication. A total of 100 participants will be approached, and each group is proposed to have
42-45 participants. Nor recommendations will be given by the physician for taking vitamin
supplements during the period of interventions. The participants may have stable drug dosages
for hypertension and diabetes.
Inclusion/Exclusion Criteria
The age range for elderly subjects with type 2 diabetes is 40-80 years. Subjects less than
59 years old will be allocated to younger group of intervention, and those of 60 and above are
allocated to elderly group of intervention. The participants chosen should have diagnosed with
type 2 diabetes and are excluded if they are alcoholic, smoker, and do not have stable medication
for last 30 days. Participants will be included if they have the willingness to seek yoga

5OXIDATIVE STRESS IN TYPE 2 DIABETIC PATIENT
intervention. Further participants with cancer, pulmonary tuberculosis, and acute macron
vascular complications, history of osteoporosis, rheumatoid arthritis, history of infections or
those participating in any weight loss programme are excluded as it may hamper results.
Yoga intervention
In the yoga centres of the hospital, the chosen participants will be instructed to attend the
yoga classes as per their convenience. Each of the participants must attend 70-90 minutes of
yoga every day and may take a break in weekend. For the participants with heart disease the
floor exercises may be waivered (Deshmukh and Bedekar 2015). Based on the literature review
the set of yoga interventions selected for the study are:
Yoga poses Duration of yoga
Triangle pose 3 min
Tree pose 3 min
Mountain pose 2 min
Forward bend pose 3 min
Cow faced pose 4 min
Seated forward bend pose 4 min
Extreme sideways stretch pose 3 min
Wind-relieving pose 5 min
Twist pose 4 min
Thunderbolt pose 3 min
Corpse pose 10 min
Alternate nostril breathing 10 min

6OXIDATIVE STRESS IN TYPE 2 DIABETIC PATIENT
(Sources: Deshmukh and Bedekar 2015)
Compliance with intervention was determined by maintaining the attendances for at least
three days a week for one year
Measurements
Before the start of the intervention, the eligible participants will be invited for the
baseline evaluation. It will include blood glucose measurements, complete medical history,
serum creatinine, ECG, microalbuminuria, lipid profile, and for any complications associated
with disease. It will prevent the bias in the results (Deshmukh and Bedekar 2015). After the
intervention again the same measurements will be taken as in done in similar study conducted by
(Chimkode et al. 2015). Physical examination of the participants may include measuring by the
electronic scale the weight in Kilogram (Kg) and the height in centimetres (Cm). Plasma will be
analysed for glucose. For this purpose 7 ml of venous blood will be collected, red blood cell
hemolysate will be prepared to analyse the reduced glutathione levels and
malondialdehyde/MDA (Hegde et al. 2013).
According to Furukawa et al. (2017), MDA is the marker of oxidative stress. It gives pink
colour upon reacting with the thiobarbituric acid reagent. It can be estimated
spectrophotometrically at 535 nm. Thus, MDA assay will be measured using suitable assay and
using a standard laboratory method the Plasma glucose will be assayed.
Ethics

7OXIDATIVE STRESS IN TYPE 2 DIABETIC PATIENT
Prior to proceeding with the research, approval from the ethical board or local committee
will be taken. The participants will be explained about the study design, and informed consent
will be taken. Adequate measures will be taken to maintain the confidentiality, privacy and
dignity of the participants (Creswell 2013).
Statistical analysis
The parameters obtained will be statistically analysed using appropriate SPSS tool. For
comparing the continuous variables, paired t-test will be used. A difference of the parameters
between two groups will be measured by the Mann-Whitney U test. Correlation testing includes
Karl Pearson's coefficient of correlation. Statistical significance will be understood by the p-
value <0.05 (Alfonso‐Rosa et al. 2015).
Importance, relevance and impact
It is expected that the yoga interventions will improve the oxidative stress in the chosen
participants. The results will be relevant for the clinician and the nurses as they can recommend
the patients to attend yoga classes for improvement in oxidative stress and decreasing
comorbidities of type 2 diabetes. The government can be recommended for establishing the free
yoga centres in low socio-economic communities with high prevalence of type 2 diabetes. It will
be beneficial for not only the diabetes patient, rather others at risk as well as it may reduce the
risk factors. Thus the selection of the topic is justified, and the results are expected to be viable.
There are several implications for the future study. For instance, if the results are positive then
the intervention can be targeted for larger population to know how long the benefits may last.
Further studies can be designed such as to evaluate the yoga poses most beneficial for the
diabetes patients.

8OXIDATIVE STRESS IN TYPE 2 DIABETIC PATIENT
Conclusion
In conclusion, a suitable and cost-effective intervention that is Yoga is proposed for
determining its effect on the oxidative stress in the elderly subjects with type 2 diabetes. The
intervention and the outcome measure is designed based on the literature review of similar
studies. This research proposal will help identify if the yoga intervention is beneficial in
improving the oxidative stress and the glycemic status. Further, the difference in the effect on
oxidative stress due to yoga in elder and the younger patients can be determined. Hopefully, the
data obtained from the research will support the intervention and help in further optimising the
duration of intervention and its content. It will further increase the research knowledge and help
identify any flaws in the research design

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