Neuroscience and Yoga Online Research Pilot Results

Hello everyone. Welcome. I'm so glad you can all be here. I'm really excited to share the results of the Neuroscience and Yoga Online Research Pilot with all of you. And I'll just give a little bit of an introduction. So I'm Jonathan. My biggest goal is to share neuroscience and yoga with everyone. And the Most recent project we have doing this, and I'll tell you who we is in a moment, is the Neuroscience and Yoga Online Research Pilot. And I really hope you'll walk away from this session with a little more of an understanding of what yoga research is and why it is important, and some inspiration to participate in yoga research going forward and maybe even partner with us, which we'll talk about at the end. And we'll talk about the goals of this and all of that in the next few slides, but I want to— Emphasize that this is a pilot. And so we're really testing the feasibility of conducting neuroscience and yoga research online. And so I really encourage questions as we go through this. Please type them in the chat so that you don't forget them. And there will be time at the end so that we can go through all the questions. And that's when I'll unmute everyone. So I'll introduce the team. So 3 of us had a conversation almost a year ago at this point, talking about how cool it would be if we could make yoga research more affordable, faster, more automated, and reach more people. And we thought doing it online would be the best way to do this. And the 3 of us were, or are, Jess Ruhland, Kristen Anderson, and me, Jonathan Rosenthal. And we all have some background in research. Jess does work in movement research and dance research. Kristen is a neuroscientist. She just finished her postdoc at Columbia and moved to Ireland this past week where she's going to be heading up A neuroscience outreach program there, and I am a neurologist, which means I treat patients with neurological diseases. An outline of this talk, we're going to go over the goal of the study first. Then we'll talk about the structure. So how we tried to accomplish that goal, and we'll go through the results. So we'll start with the demographics of the participants, and then we'll go through each of the individual tests that we conducted. And then finally, we'll talk about what I think is the most important part of the presentation, next steps and conclusions. Okay. So we'll start with the goals of the study. So when thinking about a neuroscience and yoga online research pilot, we really were trying to address a problem, which is that high quality science is expensive and neuroscience and yoga research is underfunded. And so when we were thinking about how we could do this, we were thinking students already take a ton of yoga classes every single day. And the most recent statistics that I could find were that students are spending about $16 billion a year on classes just in the United States alone. So what if we just put neuroscience experiments before and after those yoga classes that students were already taking? And we thought that this might help us achieve making yoga research cheaper, meaning like more affordable. I hate the word cheap, more widely understood and accessible to people everywhere. And so, yeah, we're really testing out a different way of conducting online yoga research. And then because this is a pilot and this is our first time doing something like this, we're identifying ways to optimize the approach. And that's something that hopefully everyone can brainstorm and think about as we're going through this. How can we really improve this? And then lastly, this is the best part. It's connecting with everyone like you who's interested in this topic. And yeah, that's really the 3 main goals we have with this neuroscience and yoga online research project. And I see Jess just got here. Hi, Jess. And I just want to point out, like, for this pilot, we're not trying to achieve specific outcomes with the data that we're collecting. We're not like, oh, we have to show that there's a change in heart rate variability. We have to show that there are cognitive changes. We're really trying to show, can we conduct research this way and are we able to trust the results that we're getting? So how will we feel if we accomplish our goals? We're going to feel like this. So let's see how we do. So the structure of the study. So to go over the structure, just a few terms to make sure everyone's on the same page. So acute means immediate and chronic means long-term. So we're going to be looking at both acute and chronic effects of yoga in this, in And this is a very big outline of how the study worked. The basic structure, even before looking at this table, is that people signed up with their name and their email address, and they paid $30, which was about $5 per yoga class. We didn't recruit particularly intensely. We just sent 2 emails out and we mentioned that we were just testing this method and we really wanted to see how it went for everyone. And Once someone signed up, they received automated emails that gave them their weekly assignments, and that included 2 yoga classes per week. They could squeeze it in at any point during their schedule as long as they did both of them each week. And once the links were clicked, it went through a standardized sequence. First, you're going to do these experiments, then you do the yoga class, and then you do experiments after the yoga class. And this table shows what each of those 6 classes was. So 2 classes per week for 3 weeks gave us a total of 6 classes, and there were 6 experiments that were included. So HRV is heart rate variability, PCS, Pain Catastrophizing Scale, STAI was the State-Trait Anxiety Inventory, the Stroop test, the emotional Stroop. And the reading the mind in the eyes test. We also included heart rate variability before and after each of the experiments just to use the experiments as a type of stressor. And the other thing you'll notice in this table is that there were pre-yoga experiments, then the yoga intervention, and then post-yoga experiments. And so the idea was for each of those 6 studies, heart rate variability, pain catastrophizing, state trait anxiety, Stroop, E-Stroop, RMET, people would do them. Once at the very beginning and once at the very end. So that's here and here. And then that would really measure the chronic effect. So we're looking, how did it change from the beginning of class 1 to the end of class 6? And then we also included one each week that was an acute effect. And so Stroop was before and after, RMAT before and after. ESTRU before and after, state trait anxiety before and after, and then pain catastrophizing was before here and then again here, but that also measured the chronic effect. The yoga intervention varied from about 62 to 79 minutes, and it included postures, breathing, concentration, and relaxation. They were all classes that I had recorded before that I taught as regular yoga classes at the school I teach at, the Dharma Yoga School. And then We also had people report a lot of different things about themselves. So demographics like age, education, how much they practice at baseline. So number of classes per week and whether they consider themselves beginners, intermediate, or advanced. We also looked at whether they liked the yoga classes to see if that could have an effect. Then we measured things like how long they were spending on each of these tasks. So we could look at that too. And so this is really a structure of what the study was, what we were doing in order to achieve our goals and see if we could find any effects. So if there are any questions, remember to put them in the chat and we'll answer them once we get to the question section. So now we can start going through the results. So we'll start with demographics. And I'm just gonna show you in some figures. What the demographics of our sample were. So about 71% came from the United States, another 14% from the United Kingdom, 7% from Latvia, and 7% from Poland. 86% of participants were white, 7% were Asian, and 7% identified as other. These were self-report. 93% were female, 7% were male. And we had an average age of 42.4 with a standard deviation of 13.5. And then we had 57% that I identified as intermediate in their yoga practice, 14% as beginners, 29% as advanced. 36% of them practiced 21 times per week, 14% 16 to 20 times, 7% 11 to 15 times. 14%, 6 to 10 times, not per week, per month. I'm so sorry. And 1 to 5 times, 14%, and 0 times, 14%. So we did have a number of people who didn't practice yoga at all. And in terms of education, 64% had a doctoral or professional degree. So a very educated bunch and 36% had a college degree, again, a very educated bunch. We asked people why do they practice yoga, which is always a fun question. And we have this sound, this word cloud representing it. So words like mind, health, stress, calm, enjoyment, teaching, helping, healthy fitness, awareness, all of those seem to come up quite a bit. Vitality. And now we can really get into those 6 experiments and what we found. So the main outcomes, the most important one to me is really how many people signed up and stuck with it. And these are those data. So these are over time, the 6 classes and the number of participants. So in the first class, 14 people completed it. And then there was a pretty big drop-off by the second class, only 9 Completed the second class, and then 8 for the next 3, and we ended the sixth class with 7. And so only about 50% of people who signed up actually completed the full intervention. And so we had really 2 big questions because this was a pilot, right? So the first question is, would people sign up for something like this? And it seems like the answer is yes. So 14 will. And then the next question is, will they stick with the program? And that answer is it's about 50%. And so one of the things we really need to think about is how we can improve that. This is called attrition as people drop off in a study. So we want to think about how we can make it more engaging and keep people around for the study. Okay. And now I know everyone's really interested in the 6 experiments and what they showed. So we'll start with heart rate variability. Just as a review, I'm not going to go too much into the physiology of any of these right now, just because we have so many to get through. But as a quick review, so heart rate variability is the physiologic variation in the time between 2 heartbeats. And this happens from multiple different rhythms. One of them, the most predominant, is the breath. This is called the respiratory sinus arrhythmia. And so inhalations speed up the heart rate and exhalations slow it down. And Heart rate variability is controlled by the balance between the parasympathetic nervous system via the vagus nerve and the sympathetic nervous system via nerves that run along arteries. And these are the data from our 6 classes. So we measured heart rate variability before stressors and after stressors and before yoga and after yoga for every single class. The only exception is class 1, where after the yoga class, there were no stressors. So we just have post-yoga there. And what you'll notice, the first thing that stands out to me is that the error bars here are gigantic. So with a sample size between 7 and 14 people for each class, there was not enough signal-to-noise to really detect a difference. And so when we do our analyses, we see no real difference between any of these groups. The only exception was on Class number 5, this was the one where State-Trait Anxiety Inventory was the stressor. So they made self-report of what their anxiety level was. And here we can see that to some extent, there's a little bit of a drop, maybe a trend, definitely not statistically significant with the stressor, but then after yoga, their heart rate variability increased significantly. And then with the stressor again, came back down. And we can see that the p-values for these were significant, less than 5% that this was due to chance. We've definitely seen in many of our studies in the past where we look at heart rate variability and increase after yoga, and this is what the scientific literature seems to support. But usually those sample sizes are more like 20 to 25. I think that's really where you start to get the signal-to-noise ratio you need to see this change. And yeah, so this is the heart rate variability data. One of the other things we really need to be able to do is replicate other scientific work. So in order for science to be meaningful and to be believed as true and valid, you really want to show that you get the same results when you do the same intervention and the same study conditions. And so I think the difference in sample size explains some of the differences here. But another interesting thing to look at to try to confirm, are we replicating other work, is to look at heart rate variability compared to age. And it's very consistent in the scientific literature that as people age, their heart rate variability goes down. And we find the same thing in our sample here. So you can see this, not significant, but I think visually you can see it, that there is a trend towards lower heart rate variability as people age. Okay. So keep the questions rolling in. I see the chat has some in it. All right. So those are heart rate variability. Feel free to add more questions. The next one was the Pain Catastrophizing Scale. So pain catastrophizing is a measure of the mental experience of pain. And it really looks at domains, rumination, magnification, and perceived helplessness. So the amount that people fixate on a topic, disproportionately assign weight to it, and then do not see a path out of it and consider themselves a victim. And there's a standardized scale for measuring this where people answer survey questions called the Pain Catastrophizing Scale. So we included Pain Catastrophizing Scale data in our research pilot, and these were the results. Really no differences. So blue is at the beginning of the study. Green is at the end of the study. At the beginning, we had 14 people completing it, and at the end, we had 7. And you, I actually ended up excluding anyone who didn't complete it. So really it's 7 in each of these bars. So 7 people are combined in the average of each of these bars, and we're comparing before and after for each of these groups. And you can see that it's pretty much the same. It even looks a little bit like there's more pain catastrophizing at the end of the study compared to the beginning, but this was not a statistically significant difference. It may just be A trend. Maybe my yoga classes hurt people. Unclear. Okay. And I know I'm going through this quickly. I apologize. I want to leave time for us to discuss next steps with the program. And I'm really just showing these data more out of interest, really. I think the real benefit will come from talking about how to improve studies like this. Okay. And now the Stroop test. So what is the Stroop test? It is a measure of cognitive control. Which is the ability to prioritize behaviors that meet chosen goals. And so the Stroop test is a really cool and fancy way of measuring this. It's very old. It's been around for many decades. And the way it works is a subject is presented, they basically have to control how they respond to a visual stimulus. So the word will spell out a color. So it'll say R-E-D for red, but it could be written in blue or green or other font colors. And it can be very difficult because you're seeing a different color, but you're trying to respond with what you read. And so you really have to prioritize how you're interpreting stimuli. And there's a distinction between congruent and incongruent stimuli. So a congruent stimulus is when the color of the text and what the word spells out are the same, and incongruent is when they are different. Okay. And so. For our study, we had people complete Stroop tests at the beginning, at the end, and then before and after a yoga intervention. And what we really see is that there's just an improvement from the beginning to the next one. And there was no significant yoga between these because the Stroop test intervention was the second class that everyone took. And so really what this suggests is that the difference was practice effects. Meaning that if you do a Stroop test, you just get better at it because you're used to it. You get faster at it. So the main performance outcome is reaction time. And do we know that maybe the people who are doing yoga would do better than a control group? So maybe there's an improvement from yoga even in addition to the practice effects. I can't say, we don't have a control group to compare to, but that would definitely be something that we want to do. I will say that there is scientific literature where Stroop test performance has been compared to a control group after yoga, and there is an improvement on top of the practice effect.

Okay.

Again, I'm moving fast. I apologize. I'm just leaving time for discussion. And now, State-Trait Anxiety Inventory. So this is a standardized survey that's used to measure anxiety, and it measures 2 different types of anxiety. Which one of them is trait, which is your general character baseline, just like how anxious are you as a person? And the other is state, which is how anxious are you in this moment? And so you might think about how does yoga affect state versus trait anxiety? And so these were our outcomes for this. Again, we have at the beginning of the 6 classes, so at the beginning of the 3 weeks and at the end of the 3 weeks, and then before and after a yoga intervention. So the chronic and the acute effects on the left is state anxiety and on the right is trait anxiety. And in this 3-week intervention, state anxiety chronically, so from here to here, was significantly improved. So state anxiety was chronically significantly improved. In terms of acutely, there was a trend towards improvement, but this did not achieve statistical significance. And then for trait anxiety, Chronically, there was a trend, but not statistically significant, and there was no acute trait effect on anxiety. Okay. And now the emotional Stroop. I think this is the hardest experiment to understand, really. So similar to the regular Stroop, the emotional Stroop is a test that measures cognitive control by asking a subject to respond to a particular feature of a stimulus. But what's different is that the stimuli, they're different in their emotional salience. So one of the words might be gate, G-A-T-E, which is a pretty neutral stimulus. And then the other word that corresponds to it might be hate, which is one letter different, but has a very different affect to it. And what's been revealed in the scientific literature is that when subjects have mental health conditions like depression, their reaction times are slower for these emotionally valenced words. And so we might hypothesize that if yoga improves mood and self-regulation and cognitive control, perhaps emotional Stroop test performance will improve when these affective words like hate are presented. And so when we look at our results here, so again, acute and chronic effects. And when it says congruent and incongruent, so congruent is the not emotional words. So the kind of neutral words, and then incongruent is the very affective words. And what is, there are both acute and chronic performance improvements for both the affective and neutral conditions. And I'll just let that sink in for a second. I see a couple people writing.

Okay.

And then the next one is the Reading the Mind in the Eyes test, the RMET. And what this measures is empathy, which we can define as the ability to accurately perceive the feelings of others. And we do this on some very— it's incredible what stimuli we can use to infer empathy. You can read it in someone's language. You can read it on their face. You can see it in their body language, right? So you can really extract emotional information from so many different sources to generate your empathy. And so the Reading the Mind in the Eyes test is an experiment where participants are presented the images of eyes of actors that were told to present different emotions. And then the subject's job is to identify what emotion were they displaying. And so better performance is just getting more of these correct. So looking at the Reading the Mind in the Eyes test, on the left we look at their accuracy, so their score itself, and on the right we look at reaction time. So on the left, we'll start with that. You can see that chronically there was no effect. So that's this bar right here. And then this really isn't acutely. So this is the first time they took the test and the second time they took the test. Both of them were before a yoga class. So there, if anything, it looks like people performed significantly worse after they took a yoga class. Maybe the yoga made them tired and they weren't able to complete the task as accurately. I will say the literature that's looked at the RMET in regards to yoga, the interventions, instead of being a full posture, breathing, relaxation, meditation, yoga class, they were a loving kindness meditation for about 20 minutes. So that's a meditation where people sit. And are walked through a very standardized way of imagining the faces of others and cultivating compassion for them. So in those, people do show more accuracy after a loving kindness meditation, but we saw the opposite with our yoga intervention. And then in terms of reaction time, it just got better and better and better every time they took this test, which makes sense, right? Either they got faster at recognizing the eyes and knowing what they wanted to answer, or they just got tired of it and got lazy, but both Make people a lot faster. Okay. So those were the results of the 6 different experiments. So some other findings, I just did some extra analyses that are of interest. So these are a correlation presentation. So on the top, we're looking at class 1. So the first class that they took, the state trait anxiety. This one was just state. So state anxiety versus pain catastrophizing scale. at class 1, and then on the right is trait anxiety versus pain catastrophizing scale. And then the bottom row is the same but for class 6, so the last class that they took. And what you can see is that especially for trait anxiety, there is a strong correlation between trait anxiety and pain catastrophizing scale, meaning that people who had higher trait anxiety tended to have more Self-reported pain catastrophizing. State anxiety was similar, but not as strong, though both were statistically significant. And then by the end of the study, the trend still seems to be there, but we lose statistical significance because there were only 7 people and it's, the signal-to-noise ratio went way down, way more noise.

Okay.

And then the next one was looking at state anxiety and trait anxiety versus heart rate variability. And for this one, we noticed the opposite. And this for state anxiety was statistically significant, showing that as heart rate variability went up, anxiety went down. So people who had more heart rate variability, higher heart rate variability tended to be less anxious. And there's no causation implied by that. It's just a relationship. And for trait anxiety, visually, maybe there is a trend like that, but it was mathematically nothing. And then the After yoga, this relationship actually went away, which I found very interesting. So before yoga, heart rate variability and anxiety are very correlated, but after yoga, acutely, that relationship goes away. Unclear why. We can do all the speculation we want later about why. Okay. And then you may also want to know about analyzing by practice level, like beginner, intermediate, advanced, or the number of classes that people took. I did do these analyses. I did break everything down by that. The numbers were so small in each group. So remember at the end of the experiment, we had 7 people total. Each of those groups maybe had 2 to 3 people. So I really don't think it's fair to interpret those. It's just not enough data to interpret. And those are all of the data that I'm going to present. We can go back to answer people's questions. So I'll start by saying thank you, Jess, for being here. Eddie is asking, how How did you measure heart rate variability? So we used an app, which is not a research-grade app, admittedly. The next time we do something like this, we will use a research-grade app. But basically what it did is have participants put their finger on the back of their phone camera, and then the pulse can be detected by the camera. It's a technique called photoplethysmography, and the time between beats recorded from the finger is what was used to generate the heart rate variability numbers. And we used the root mean squared of successive differences. Which is a specific measure of heart rate variability. I will say that photoplethysmography does have some issues. So if someone's hands are really cold, that can actually mess it up. And a lot of people have trouble recording with this app. So there were some people whose data were missing for this. How did you recruit your subjects? That's a great question, Leanne. So we did not recruit very hard. We just sent 2 emails to An email list of people who have attended our events in the past. That was all we did. We weren't trying to get a ton of people for this one. We were really just doing a pilot and seeing how this would work. Kendral asks, since 93% were women, do you take any— oh, that's a great question. We did not take any data on where in someone's menstruation cycle they were. That would be a great idea to include for later because that does affect A lot of physiological variables. And if we wanted to do a multivariate analysis, we could control for something like that if we know that. And over how many months did you conduct this test? So it was asynchronous, meaning that the time that someone signed up, they could complete it whenever. So the first people started completing the study in January and February, and then the last people completed it in April or so. And once they started, it was a 3-week intervention for that person. But the study was ongoing for a few months. Any specific observations between men and women? I did want to look at this, but there was only one man in the study. And so it is really not a fair comparison. You can't take an average of one person. Your comment about the different effect of loving kindness meditation versus a full asana practice on empathy makes me wonder about running a similar program, but with 3 groups, one meditation only, 2 gentle yoga and brief meditation, and 3 power vinyasa. Jess, I completely agree. I think that's really where this kind of research program online can shine, is that we now have the ability to very exquisitely manipulate every condition. Whereas previously, if you did yoga research in person, you needed the teacher to do exactly what you wanted as the intervention. And if they had to do it over a 2-month period, they had to do it right every single time, which is really hard to do. Whereas if we do it as a video intervention, it is much more standardizable and much more controllable. And yeah, we could even randomize people so they could sign up all for the same link and then be randomly sorted into which intervention they're going to get. And that is a great study idea. I think we should talk more about that and I'll have a link at the end where you can submit that idea.

Okay.

And then Kendra raised her hand. I will unmute you.

Thanks for sharing all this data. I am also curious if they all attended the same yoga class or similar style. And it also makes me wonder that for the emotional stroop test, if the season would make a difference. For example, on the East Coast being cold, days are shorter. If that would have influenced the data in any way.

Yeah.

Thanks.

That's a great question. So all of these were conducted in winter in the countries that everyone reported coming from. So people were from the United States, the United Kingdom, Poland, and Latvia. And all of those places had their season as winter from January to April. As far as I know, I think that's true. So that should be the same for everyone in this sample. And then in terms of your first question about what the yoga intervention was, so it was a recording of a yoga class. These weren't live yoga classes and people basically were displayed a video and went through it. We know how long people spent on each of those videos, so we know if people didn't complete the yoga class. I didn't exclude anyone based on that, so we kept this as an intention-to-treat analysis. But we could, if we really wanted to analyze it a different way, exclude people who didn't complete the yoga class. And the yoga class, as shown on this slide, varied from 62 to 79 minutes, and it included postures, breathing, concentration, and relaxation. I'm happy to give more details on the yoga classes. I could also share videos of what they were. Yes. And then Mary is asking, when did participants take the test? Yes, it was right after the yoga classes. So they took tests right before the yoga classes and right after the yoga classes. And then the main goal of a pilot is always just to really understand, is this going to work? Can we conduct research this way? And so that's really our main goal. All of these experiments that we included were just ways of Validating and replicating other research and confirming that we're getting the same results as other people, basically saying that conducting these experiments in person and online yield similar results. That was the goal of this pilot. Oh, Steven, great question. How much influence do you think the teacher has on the results? Do you think that different teachers will draw different results if the students know the teacher, et cetera? I 100% agree. We, included 2 questions to get at this. Jess is really interested in this question. So we included if people liked the class and liked the teacher, and they said whether they strongly disagree, somewhat disagree, neither agree nor disagree, somewhat agree, or strongly agree. The, there wasn't enough variation in that to analyze whether that made a huge difference on outcomes. And so I can't answer that question right now, but my suspicion is yes, I think that will make a difference. And I think once we conduct the same kind of study in a much larger sample, we'll have more variation in how much people like the teacher and classes and be able to stratify by that. So are we only understanding the physical practice or all aspects of yoga? And the answer is all aspects of yoga. So yoga is a complete practice of postures, breathing, meditation. relaxation, ethical rules, personal observances. And so we do try to include all of these. How these were included in this class, there was a little bit of spiritual knowledge talk at the beginning, and then postures were the majority of the class. There was a breathing intervention at the beginning and at the end. There was some concentration with the breathing and then a 10-minute relaxation at the end. There was no logic to the variation in the duration of the yoga classes. It's just what was, what the recordings we had were. And then Mary, you wanted to ask a question?

Yes, it's easier like that. My question is, how long did the test take?

So great question. So on class 1, like doing all of these together, it took about 20 to 30 minutes. Same thing here for class 6. But then for the days like this where it was just one surrounded by heart rate variability, those are about 10 minutes. Mm-hmm.

And that's exactly after the class because I know that I'm after class, I really don't want to do any tests and I just wanna enjoy the feeling afterwards. And I also asking, or I ask myself, have you thought about changing the target group? I'm doing like a pilot study as well and with the topic cyclical changes in energy metabolism, like glucose levels in healthy female athletes with their regular cycles. And we work together with the app. It's called Wild AI and it's like, yeah, like a cyclical daily book for the girls so they can put in the, all the, what we decide they should put in there, like all the symptoms and also the heart rate variability. And most of the girls who use this app, they are athletes and All these girls, they have like the chest strap and they are used to do, use like measure the HRV in the morning. So maybe it's interesting to work with kind of these, yeah, like white AI people together who already have a lot of, yeah, participants who are really interested in stuff like that.

So I think that sounds really interesting. I do think that the best studies have a specific population group. For this, we specified that people should be between 18 and 65 and should— we rate, and they could practice yoga of any frequency. It didn't matter what level they were, if they had to make adjustments. The only requirements were that they had an internet connection and could do 2 yoga classes a week. But I completely agree. If you want to study yoga as an intervention, you want to have a specific patient population to apply it to. So I think going forward, that is going to be the direction that we take.

Because we did like a starter. or information about the study planned and afterwards created kind of Typeform, who's interested to, to join the study. And we thought like before that maybe 50 or a few more are interested and we got more than 1,000, more than 1,000 who are interested.

Wow.

Quite easy for them to figure out who's, for example, doing yoga because they put it in the app. What I mean with that?

Yeah, yeah, yeah.

That's amazing. We need to talk more about this.

Yeah, maybe.

At the end, I have a signup. I'm just going to ask you to put your email in it and then we can be in touch.

Yeah.

Because I actually know how it's hard. I'm also like a free scientist and not dependent on, on, on any university. So it's really hard. to do that, but sometimes it's easier when we connect. Yeah.

This is perfect.

It's great that you're doing that.

Yeah, this is perfect. I think a lot of people are gonna be interested in everything you have to say, Mary. We need to talk more. And then I'm gonna, I'm gonna move on just for a little bit. I just wanna go over some of the limitations and next steps just so that we don't run too late. But I will leave time at the end. We can go as long as we want at the end. I'm just finishing up so that if people need to go, they can. So in terms of limitations of this pilot, so it's really important to understand the limitations of any scientific study, and this one was very limited. So there was no control group. We didn't randomize people, and we really don't have any comparisons for each of these interventions. Like I said, practice effects might underlie a lot of what we saw. Uh, in terms of attrition, so we talked about this briefly before, but this is an issue because maybe people just stick around because they like it. And if people, and they're noticing positive effects from it, so if only If only the people who notice positive effects stick around, now your study is completely biased. So we really need to work on the attrition issue, which is one of the things I want to talk about. And then the other main limitation is we had a lot of experiments going on at the same time, and you can get what's called interference. So when you're doing a lot of experiments at the same time, you could get fatigued or just like lazy and sick of it. And yeah, like then you're not gonna perform as well on the other experiments. I think that also could have contributed to our study.

Yeah.

And we really need to work on the demographics. So as you saw, a very significant portion of our population was very educated, a very similar population of people who are already practicing yoga in the United States. And we really want to be able to open this up to everyone and understand how yoga impacts all areas, all parts of our population. And one thing that's really interesting is this was not conducted in a laboratory. This was all conducted in people's homes. Maybe their kids were running around, maybe their pets were licking their feet. face while they were practicing, but we were still able to find some interesting effects. And I think that this type of intervention is more real. If we find effects in this intervention, it means that video yoga interventions that are asynchronous are effective. And this is an intention-to-treat analysis that's highly scalable and affordable. So I think it's super informative to find. Any effects from doing this type of study. So I really wanted to discuss with everyone next steps, how we can keep improving this research program and work together. I know everyone here is really interested in this topic, and I think we're all better together and we can come up with some really cool study designs. And yeah, I'm gonna turn it over to Jeff to lead this section. But these were just some of the things that I thought should be next steps. So for attrition, I think we can give people half of their money back or something like that if they complete the study. We can also have regular praise and feedback as people complete parts of the study. So like milestones. For the control groups, I've actually already tested this and it works really well. So I can, once someone signs up, they can be randomly sorted into different groups. And I think other next steps include finding studies that we think are really important in the yoga research literature and replicating them just to show that this online intervention has the same effects. And then in terms of recruiting a more diverse study population, I think this involves partnering with yoga teachers in a lot of different communities and embracing advertising methods, maybe Typeform. As Mary said, is the way to go to reach more people. So I'm gonna leave it to Jess. We can all now have a group discussion. I think there are a small enough number of people that we can as a group just talk about what we think next steps should be. And I, everyone should have the ability to unmute themselves now.

Okay. Can you hear me?

Yep.

Okay, great. So nice to be with everybody on this Sunday. So the first thing that we kind of were hoping to tackle within the structure of the study was looking at the problem of attrition. So we really want to increase the rate of the people who complete all 6 classes, particularly in an online experiment where we have maybe perhaps more access to digital features, but there's potential for less human connection that you would have. In a shared physical experience. So just looking at some of the options really to improve the meaning that everyone can derive for themselves individually from the study and things that can improve sort of structural motivation to complete all of the classes. We were really looking at 3 main goals. And the first would be issues with like goal setting. So I'm sure we've all been in those yoga classes before where we've had to set an intention. So we were thinking perhaps there might be a way for individuals to set their own intentions, but to make that have like digital reminders. Perhaps there's an email that's sent out at the beginning of each of their 6 classes that would remind them of their own individual reason of why they wanted to participate in the study. So that's one option. The second thing that we were looking at was the importance of feedback loops. So people could do a little bit more self-assessment as they're progressing through the study. So we were looking at the potential for different apps that are available, different technologies that are available, things maybe even like eye tracking, where we can look at how people are progressing in the stages of learning, what their adrenaline levels are. A lot of those kind of technologies are mostly only available in laboratories, things like fMRI studies, but I think there are Starting to have more options on the market where we can actually get empirical data on how people are doing physically that would indicate what their challenge level is and give them a little bit more interest in like how they're actually performing in the study, which potentially could help people stay motivated to see maybe improvement over time. And then the third thing that we were looking at was actually the fear of failure. So I think Jonathan mentioned the financial incentives Could be a great way to motivate people at least to complete the 6 classes. If you get all 6 classes done, then you get your registration feedback, something like that. So those are just 3 of the options that we were looking at between the goal setting, feedback, and any kind of a fear of a sort of a failure aspect in completing the experiment. But I think we would love to really open it up. I know this is a really educated group and there were already So many great suggestions of technologies and different apps and things like that. So we would really love to hear from everybody here if you have any ideas about improving the structure that would keep people motivated throughout the experience and improve it.

Mics are open. And if anyone went through the study, you don't have to reveal yourself. You can always just tell us if you wanna be private.

I'll just share if that's all right. I, I'm a studio owner and it's It's taken me a little while, but I finally got to partner with a local university who has a yoga minor studies program. And partly because I really am interested in trying to further research, although I'm not a, a scientist per se. But I would imagine with both the yoga minor studies and the teacher trainings that we run to make it a requirement of completing the program and to participate in something like this could potentially help with Attrition. And then also when you're dealing with the university population, it's a pretty age-specific group. So that sort of narrows some of the diversity. So I, I would just think that maybe, yeah, if we set it up in a way that to participate is required in order to actually get your certification. And then also even just with the yoga studio population, maybe some sort of just reward program within the studio that they get a 5-class pass or something if they do the program and through to completion. Like your monetary reward for us. That would be my 2 thoughts.

I love that.

I had also, I don't know if you can still hear me. I had also had a thought about just the feedback of seeing yourself in the space. Like I was looking into even like green screen apps and designing your own sort of like sim yoga experiment, like a digital yoga studio where you could see yourself on the screen. I think, I don't know if like camera phone and computer cameras are quite advanced enough for that yet, but I don't know if some people know anything about that kind of thing, like digital avatars, I think would be interesting.

Great. So a couple things. One is looking at some real-world data and looking at who would really benefit from this type of intervention so that they might have some sort of internal motivation. Thinking of like pain clinics, and you might be able to cull some data from just their source documents about the frequency of the pain in Yeah. Incidents, and then you could look at a meaningful change from that baseline. When you're dealing with yogis and just thinking of your list, obviously is people who are, probably have at least some interest in yoga, but looking instead at those who would really get a tremendous benefit, not that yogis don't, but those people that, that would benefit. And then also thinking from a monetization standpoint is if you can show a meaningful difference in something like a pain clinic, there may be some grants or other funding opportunities available there.

Yeah, that's a really excellent point. Andy?

Hi. Yes, I had similar ideas, Leanne, in terms of getting some real-world data, maybe partnering with a local nonprofit that can reach more diverse communities. And then also really thinking about if we are going to use technology reaching those communities, a lot of people aren't going to have a smartphone. So how are we Maybe providing some digital tools, digital access is really important, and maybe having some way to like recycle technology or, yeah, I think that's the thing. Just thinking ahead about how, what those steps would be. Another thought is the length of time. So a, a 60 to 72 minute class, even with the different components, what I found is I was a studio owner during, during the COVID excitement time, and as we moved our classes online. People had online fatigue. So thinking about shortening your interventions to 20 minutes or something that's more approachable for that beginner population and not feeling like, gosh, I gotta carve out 70 minutes for a long class. 'Cause even as somebody who practices yoga, like 70 minutes is hard to find at home.

Yeah, it's 8% of your awake day.

If you're lucky, maybe 2%.

The.

I think that that goes really well along with something I've been thinking about, which is there's not a lot of data about specific interventions within yoga and now how they affect outcomes. So everything so far is published as this is a full yoga intervention, including breathing, meditation, postures, relaxation, and then we look at the outcome. But how does each component contribute to that? How do they interact to contribute to that? And I think if you have 20 to 30 minute interventions that are online and really easy for people to do, And it's randomized. Some people are going into a relaxation group, some people into a meditation group, some people just into a posture group. You can really see what each outcome is, and then maybe later on they add on the other components that are missing, and you can really tease out each contribution.

You could even look at, Jonathan, it would be interesting to look at if you had almost like a buffet menu of interventions and allow the participants to pick on their own. You could see preferences. And you may then look at the difference of, I don't know what your, what the population you had for your study, but maybe if it was somebody who felt your class was too hard, where we see that kind of steep cliff drop-off from the first class to the second class, it may be they're like, no way, that's too hard. Where if it was something where they weren't doing chaturangas and things, if they've got wrist issues or weight issues or whatever. concomitant conditions they may have going on. Yeah, I know. Thank you for sharing the goal of the pilot, but ultimately what do you aspire to do? Because I think that will also help people stay committed to the entire length of the trial or test. And that's speaking from my own experience when I have volunteered or done anything other than, especially when there's no monetary incentive. Being tied to noble purpose really helps me stay committed. Yeah.

Yeah. So maybe like reinforcing how their participation is going to contribute to scientific research.

Yeah. Yeah.

And also what some others have shared, if you're also hoping that it will help people with pain management or chronic diseases, something like that to share, because it's like somebody's parents or grandparents have something and they've seen them suffer might make it very real.

Yeah.

And hits home. Thanks.

Yeah, no, thank you. Thank you everyone.

I think maybe you can even invite this broader yoga community to start making more donations. If you have an old tablet or something like that could just be started now just to see if that's even feasible together.

Yeah. To have the resources to get people to participate.

Yeah. There may be some data about the number of people That actually have, most people have a smartphone, Android, Google phone, iPhone. What we found in traditional drug studies is that if you give people an older piece of technology, they're less likely to use it.

Wow.

I didn't know that.

It's cumbersome and it breaks down and then they get frustrated because it doesn't load. So there's a big, sites don't like old technology. I know that.

All right. So I took down some notes. This is by no means the end of the conversation. So I was trying to think about the best way to keep the conversation going, especially with everyone's busy life. So this is like a research partner group where I'll keep track of everyone who signs up for this and send regular updates about what we're working on. And then we can all find ways to partner. I'm even thinking about something like, should we have a Slack channel where we all stay in touch? You guys can let me know what you think about that. I don't know how much people have used Slack. used services like that and if they would be more of a hindrance than a benefit. I personally like Slack. Yes, this recording will be available afterwards. You're welcome to review it or share with anyone. So once you sign up for this page, it puts your email into a list and basically so that I can send out updates whenever we have any. And you're, it's gonna send you like a welcome email that encourages you to reply with Your introduction and what projects you're working on. And I'll keep track of those too, just so that maybe if people have similar things, we can connect each other. And yeah, the images on the page are from Ramón y Cajal's drawings. They're my favorite. The first one is the trapezoid body, the calyx of Held, the largest synapse in the brain. And then the second one is the cerebellum. Okay. That really concludes everything that I have. These are just some references, which I'll share with everyone. These are just papers I find really good for the experiments that we studied. These are some more of them. And that is it.