SYSTEMATIC REVIEW Effect of yoga on health-related outcomes in people at risk of fractures: a systematic review Kawon V. Kim, Joan Bartley, Maureen C. Ashe, Zahra Bardai, Debra A. Butt, Philip D. Chilibeck, Matteo Ponzano, Isabel B. Rodrigues, Jackie Stapleton, Lehana Thabane, John D. Wark, and Lora Giangregorio Abstract: We summarized the effects of yoga on health-related outcomes and adverse events in men and postmenopausal women ≥50 years-old at increased risk of fracture, to inform the updated Osteoporosis Canada clinical practice guidelines. Six databases were searched for observational studies, randomized controlled trials and case series. Certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation handbook. Nine studies were included and reported using narrative syntheses due to the limited available evidence. Overall, the available evidence was of very low certainty. There was no effect of yoga on health-related quality of life in randomized trials. Effects on other health-related outcomes were mixed or not available in the literature. Five studies reported no adverse events directly related to the study intervention, and 2 studies did not report whether adverse events occurred. However, 2 case series reported vertebral fractures related to yoga participation, possibly due to excessive spinal flexion. Due to the limited and very low certainty evidence, guideline developers will need to draw indirect evidence from yoga studies among middle aged or older adults that are not at fracture risk. PROSPERO: CRD42019124898. Novelty:  Evidence in general was of very low certainty.  Yoga had no effect on health-related quality of life in randomized trials. Evidence was mixed or unavailable for other outcomes.  Case studies reported yoga poses involving spinal flexion coincided with incidents of vertebral compression fracture among older adults with increased fracture risk. Key words: osteoporosis, bone health, low bone mass, older adults, yoga, health related outcome. Résumé : Nous avons résumé les effets du yoga sur les résultats liés à la santé et les événements indésirables chez les hommes et les femmes postménopausées de ≥50 ans présentant un risque accru de fracture, et ce, afin de préciser les lignes directrices de pratique clinique mises à jour d’Ostéoporose Canada. Six bases de données ont été consultées pour des études d’observation, des essais contrôlés randomisés et des séries de cas. La certitude des données probantes a été évaluée à l’aide du manuel Grading of Recommendations, Assessment, Development and Evaluation. Neuf études ont été incluses et rapportées à l’aide de synthèses narratives en raison du peu de données probantes disponibles. Dans l’ensemble, les preuves disponibles étaient de très faible certitude. Il n’y avait aucun effet du yoga sur la qualité de vie liée à la santé dans les essais randomisés. Les effets sur d’autres résultats liés à la santé étaient mitigés ou n’étaient pas disponibles dans la documentation. Cinq études n’ont rapporté aucun évén- ement indésirable directement lié à l’intervention dans l’étude et deux études n’ont pas rapporté si des événements indésirables se sont produits. Cependant, deux séries de cas ont rapporté des fractures vertébrales liées à la pratique du yoga, probablement dues à une flexion vertébrale excessive. En raison des données probantes limitées et de très faible certitude, les élaborateurs de lignes directrices devront tirer des données probantes indirectes d’études sur le yoga auprès d’adultes d’âge moyen ou d’adultes plus âgés qui ne présentent pas de risque de fracture. PROSPERO : CRD42019124898. [Traduit par la Rédaction] Received 10 November 2021. Accepted 9 December 2021. K.V. Kim, M. Ponzano, and I.B. Rodrigues. Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada. J. Bartley. Patient partner, Osteoporosis Canada. M.C. Ashe. Department of Family Practice, The University of British Columbia, Vancouver, BC V6T 1Z3, Canada. Z. Bardai. Department of Medicine, McMaster University, Hamilton, ON L8S 4L8, Canada. D.A. Butt. Department of Family and Community Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada. P.D. Chilibeck. College of Kinesiology, University of Saskatchewan, Saskatoon, SK S7N 5B2, Canada. J. Stapleton. University of Waterloo Library, University of Waterloo, Waterloo, ON N2L 3G1, Canada. L. Thabane. Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada. J.D. Wark. Department of Medicine, Bone and Mineral Medicine, Department of Diabetes and Endocrinology, University of Melbourne, Royal Melbourne Hospital, Victoria 3050, Australia. L. Giangregorio. Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada; Schlegel Research Institute for Aging, Waterloo, ON N2J 0E2, Canada. Corresponding author: Lora Giangregorio (email: lora.giangregorio@uwaterloo.ca). © 2021 The Author(s). This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author(s) and source are credited. Appl. Physiol. Nutr. Metab. 47: 215–226 (2022) dx.doi.org/10.1139/apnm-2021-0736 Published at www.cdnsciencepub.com/apnm on 16 December 2021. 215 Appl. Physiol. Nutr. Metab. Downloaded from cdnsciencepub.com by 52.87.244.186 on 10/05/22 For personal use only.