Discussion
breathlessness
DISEASE, COMPLICATIONS
This study is a pioneer clinical trial that investigated the short-term acute interventional benefits of adjunct tele-yoga practice for the clinical management of hospitalized patients with COVID-19. We could establish a ~1.9-fold improvement in the clinical status on the 14th day, in hospitalized patients with mild and moderate COVID-19 (odds ratio = 1.83, 95% CI = 1.11–3.03) as compared to those with the only standard of care. The odds of improvement with yoga intervention were higher on the 7th day (odds ratio = 3.61, 95% CI = 2.13–6.10). However, the effectiveness of the intervention was not found to be sustained at the 28th-day follow-up (odds ratio 1.70, 95% CI = 0.97–2.99, We could not observe a significant effect of adjunct tele-yoga on the Perceived Stress Scale in patients with COVID-19 (This clinical exploration is one of the earliest to be reported among several other concomitant attempts to establish the efficacy of additional systems of medicine, against the combat of COVID-19, as evidenced by 67 such registered trials in the Clinical Trial Registry of India (CTRI) (The study has several strengths. One of the strengths of the study is the inclusion of WHO criteria for assessing the benefit on clinical status for patients hospitalized with mild and moderate COVID-19. This is the first report wherein yoga-based intervention was provided in a tele-mode to patients with COVID-19. This was done to prevent healthcare employees from being infected. Importantly, the trial included inflammatory markers as study outcomes, wherein an anti-inflammatory mediating influence of yoga intervention could be established to improve the outcomes of hospitalized patients with mild-to-moderate COVID-19. A key feature of the trial was the early implementation of treatment within 7 days of symptom onset (median duration of 3 days) which has been considered important for the treatment protocol, in particular antivirals such as remdesivir.The trial was limited to hospitalized patients with COVID-19 which restricts the generalizability of the findings to other populations involving home-based care. The intervention duration was limited to 14 days, and assessments were limited to 28 days follow-up; however, the continued intervention could have led to sustained positive effects with respect to late complications of COVID-19. Reporting long-term outcomes of trial participants should have been considered. Given the nature of the intervention, the study used an open-label design, which could have led to biases in patient care and reporting of data. Due to logistic challenges, the laboratory-based parameters could not be collected on the prespecified 14th day time point. There was also an imbalance in the baseline distribution of the covariate, breathlessness, indicating differences in the severity status of the subjects between groups. However, we confirmed the robustness of the primary outcome with a Overall, we could observe clinically relevant effects among hospitalized patients with mild-to-moderate COVID-19, contesting the use of tele-yoga as a complementary treatment for patients with this disease. However, the positive signal found in this small-scale trial warrants the conduction of larger trials using tele-yoga for the treatment of COVID-19.