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Development of a yoga program, based on isometric exercises in lying position for patients with chronic fatigue syndrome. 

This pilot study includes 12 adult patients with Chronic Fatigue Syndrome (CFS). Six patients were reluctant to practice yoga in the isometric mode in a seated position because of the severity of their fatigue (group 1). The other six patients had previously practiced isometric yoga exercises in a seated position (group 2). 

For 3 months, patients in both groups practiced isometric yoga exercises in the supine position,  every 2-4 weeks with a yoga instructor and at home on other days. 

The short-term effects of isometric yoga on fatigue were assessed using the Profile of Mood State Questionnaire (POMS), immediately before and after their last session with the yoga instructor. 

The long-term effects of isometric yoga on fatigue were assessed using the Chalder Fatigue Scale (FS) questionnaire before and after the intervention period.  



Results : All subjects completed the intervention. In both groups, the POMS fatigue score decreased significantly after practicing the 20-min yoga program and the Chalder FS score decreased significantly after the 3-month intervention period. 

There were no serious adverse events. All subjects in group 2 preferred the lying isometric yoga program to a seated yoga program.



Conclusions : This study suggests that recumbent isometric yoga is a feasible and acceptable treatment for patients with CFS, even for patients who find it difficult to practice isometric yoga while seated.





Chronic fatigue syndrome (or myalgic encephalomyelitis) (CFS), is a disorder characterized by persistent postoperative fatigue and by significant symptoms related to cognitive, immune and autonomic function. Currently, CFS is treated with pharmacotherapy, cognitive behavioral therapy (CBT), and/or therapeutic exercise (GET). However, there are patients who do not show satisfactory improvement following these conventional treatments.




The subjects were outpatients with CFS who visited the Psychosomatic Medicine Department of Kyushu University Hospital (Japan), and met the following criteria:  

  • insufficient improvement in fatigue with previously described treatments, including pharmacotherapy (Antidepressants, traditional Japanese medicine, and/or coenzyme Q10)

  • psychotherapy, GET, 

  • and/or autogenic training for at least 6 months

  • be between 20 and 70 years old. 

  • Patients were excluded if their fatigue was due to physical illnesses such as liver, kidney, heart, respiratory disease, endocrine dysfunction, autoimmune disease, severe anemia, electrolyte abnormalities, obesity and/or pregnancy.


Development of the lying isometric yoga program : 

We discussed and developed a 20 minute isometric yoga program

The program we had planned could be practiced by patients who generally spend most of the day in bed, without exacerbating their symptoms or causing

discomfort after exercise.

The recumbent isometric yoga program we developed was designed to be performed on a bed and consisted of three components which included: (1) adjustment of  internal conditions, (2) isometric yoga poses, and (3) deep relaxation and awakening.  


First, the greatest attention was paid to external stimuli such as temperature,

humidity, sound, smell and light, so that patients in the supine position can practice isometric yoga in the comfortable conditions with minimal stress. 

The chamber was fitted with adjustable brightness ceiling lights, which were adjusted by the instructor according to the patients' preferences before starting the session. The instructor was aware of the volume and tone of his voice. 

Patients were also asked to consider these factors when practicing at home in order to create an environment in which deep relaxation can be achieved.  


Second, the patients had to practice the isometric exercises shown in Fig. 1. These poses were to be performed very slowly while breathing, with or without coordinated sounds, and using approximately 50% muscle strength.  


Third, patients had to relax completely and then return to the active wakeful state. The session was designed to last approximately 20 min.


Isometric yoga differs from traditional yoga postures in several ways. The predominant difference is that under this new program, the exercises require isometric muscle contraction. Regarding the fact that patients can modulate resistance according to their level of fatigue, we hypothesized that isometric yoga would help prevent the exacerbation of fatigue. 

Isometric yoga poses do not include isotonic muscle contractions or stretches, and require less flexibility, making them easier to practice. 

Similar to traditional yoga poses, isometric yoga poses are performed slowly with an internal focus on one's breath, while synchronizing breath and movement, and maintaining an awareness of inner sensations.


The isometric yoga program : 

During isometric exercises, three reps were performed at approximately 50% of maximum muscle strength. Afterwards, the patients had to  relax their muscles while maintaining their position. Once completely relaxed, a return to the first position was necessary while exhaling slowly, followed by adopting a relaxing pose (Shavasana). During relaxation, changes in body sensation before and after application of the isometric load should be noted.

While relaxing, the part of the body worked in isometrics should become slightly but noticeably warm. The amount of force, the number of repetitions and the pauses between repetitions were adjusted according to the patient's degree of fatigue.

Isometric exercises :  

  1. Isometric loading of the neck by pushing it with both hands: the head should be lifted slightly before directing the force to the mat in the opposite of the resistance applied by the hands (Figure 1c). 

  2. Isometric load to turn the neck to the left and to the right: after inhaling, the head should be slowly turned to the right while exhaling, and this position is maintained until the right hand is placed on the right temple. Force is then applied in the opposite direction to which the head was turned to provide resistance (Figure 1d). 

  3. Isometric yoga for the lower back and hip: To generate an isometric load, pull the right knee with the hands towards the chest while putting force in the knee as if to extend the leg. After the application of the load, the contraction of the arms can be slowly decreased so that the arms together with the right leg can be lowered, and, relaxed with a slow stretch. The legs should open and relax to the width of the shoulders. This can be repeated on the left side in the same way (Figure 1e). 

  4. Loading and unloading of the hip: in Shavasana position, bend the elbows, place both palms on the stomach, bend both knees; the legs remain open, then bring the heels up (towards the buttocks). After the slow exhale, inhale pressing lightly on the stomach with both palms, slowly lift the pelvis, then move the pelvis down while exhaling. Once down, the heels can be carried towards the hips and glutes (Figure 1g).



Yoga intervention : 

CFS patients were asked to practice isometric exercises using the same 20-minute program for 3 months. Before and after the isometric yoga practice, the supervising physician checked the condition of the patients and recorded any adverse events or symptoms of discomfort, such as exacerbation of fatigue, pain, dizziness, or anxiety that might be caused by the practice of isometric yoga. 

In addition to receiving lessons from the yoga teacher, patients were invited to practice this program outside of the lessons provided if possible, using digital video and a "  isometric yoga program booklet  ".


Results :

The study included 12 patients (age range: 26-61 years; mean age: 39.5 ± 11.0 years; 10 women and 2 men) equally divided into group 1 (age range: 26-54 years; mean age: 34.8 ± 10.3 years; 6 women) and group 2 (age: 29-61 years; mean age: 44.2 ± 12.5 years; 4 women and 2 men). The mean age was not significantly different between the groups.



Most patients saw their doctor every 2-4 weeks during the intervention period. Therefore, the patients practiced the same isometric yoga program at least four times with the instructor during the intervention period.

They mostly practiced the same 20-minute program; however, some patients decreased the number of repetitions per pose depending on their physical condition. It took some patients 30 min to complete the program because they performed longer poses, and/or remained relaxed longer during poses.  (figures 2 and 3)

Fig.2: the  exercise practice results  isometric  short term. 
Before (
blue ) and After ( red ) the yoga session. 

Fig.3  : the  exercise practice results  isometric  long-term. 
Before (
blue ) and After ( red ) the yoga session. 

Retention rate : 

All patients completed the program; No patient ceased participation during the study.


Attendance :

Overall membership has been very good. All patients practiced yoga with an instructor in a hospital setting. Seven of the 12 patients (58%) kept personal yoga journals. Based on these records, recumbent isometric exercises were performed at home for an average of 6.0 ± 0.8 days/week and 5.6 ± 1.0 days/week during the first and last week of the period. intervention, respectively.


Security : 

No patient reported adverse symptoms, or post-exercise malaise.


Satisfaction : 

All patients were very satisfied with the program and described isometric yoga as helpful. Preferences: All subjects in Group 2 preferred prone isometric yoga to seated yoga, and thought it was comparatively more useful for the following reasons:  

  1. less energy needed and easier to make

  2. more relaxation and comfort during practice 

(3) it was possible to practice on days when sitting was problematic, and also on days when symptoms were less tolerable

(4) the program could be practiced on a bed, which was strongly considered.


Discussion :

This study demonstrated that recumbent isometric yoga was associated with decreased POMS-F (Mood State Profile) scores and Chalder FS scores.  (quiz  on fatigue) in patients with CFS (Chronic Fatigue Syndrome), who have not been able to achieve satisfactory results after at least 6 months of conventional treatment.


Patients also showed an excellent level of participation and were very satisfied with the program. In addition, all patients in group 2 preferred the lying isometric yoga program to the seated one. Their reasons seemed logical, as this was a treatment for severe CFS. For example, patients reported that they could practice (while lying down) even when they were not physically able to practice a program while seated. Additionally, they also reported deeper relaxation because lying isometric yoga expended less energy compared to a seated position.  



Conclusion : 

Overall, this pilot study suggests that the recumbent isometric yoga program is both feasible and effective for patients with severe CFS. More studies are needed to determine the effectiveness of recumbent isometric yoga.




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