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A hot yoga session at least once a week improved depressive symptoms in people with moderate-to-severe depression, researchers found.

In a small randomized controlled trial, hot yoga participants had a significantly greater reduction in Inventory of Depressive Symptomatology -- Clinician Rated (IDS-CR) scores over 8 weeks compared with those assigned to a waitlist (Cohen d = 1.04, P<0.001), according to Maren Nyer, PhD, of Massachusetts General Hospital in Boston, and colleagues.

In addition, more participants in the heated yoga arm responded to treatment as measured by at least a 50% reduction in symptoms than in the waitlist group (59.3% versus 6.3%), they reported in the . And more heated yoga participants achieved low enough IDS-CR scores to be considered in remission (44% versus 6.3%), they found.

"The main takeaway is pretty simple. It's just that there's something that exists in the community, that may help people that are feeling depressed, feel better," Nyer told MedPage Today. "There's such a shortage of mental health workers, psychiatrists, and it puts people in the power seat in terms of [doing] something on your own."

"It's group-based, it's not stigmatized," Nyer added, "and our evidence is showing that it reduces symptoms of depression."

Even though the average participation was about 10 classes over the 8-week study period -- fewer than the two visits per week prescribed in the intervention -- Nyer said patients still saw benefits, suggesting just one heated yoga session a week could be helpful.

She added that the intervention is intense. "It takes two to three classes even to acclimate to the heat and sweating ... and you're listening to this dialogue and you're trying to move your body," Nyer said. "It's not like a mild intervention. It's a different sensation. You come out and you're totally shifted."

"It gets you out of your head because you cannot focus on anything else," she added.

Nyer and colleagues noted that while there have been numerous studies of regular yoga for depressive symptoms, there's been far less work done on heated yoga. There's been one other randomized controlled trial of hot yoga, but it was in mild-to-moderate depression and it focused on women. While heated yoga outperformed a waitlist control in that study, it didn't perform better than an exercise comparator, they said.

To build on that work, the researchers included a larger sample size, all genders, and individuals with moderate-to-severe depression . They recruited 80 participants between March 2017 and August 2019 who had an IDS-CR score of at least 23.

Participants were randomly assigned to either two sessions of hot yoga over 8 weeks or to a waitlist control group. Hot yoga involved 90-minute sessions of Bikram yoga in a 105°F room.

Ultimately, 65 participants were included in the analysis. The mean IDS-CR score was 35.6, most participants (81.5%) were female, and the mean age was 32.7.

Results showed the intervention was generally feasible and acceptable, with participants generally rating the yoga sessions positively and no serious adverse events occurring. "This rigorous intervention shows that 90 minutes of high temperatures, strenuous physical movements, high humidity, and profuse sweating was well tolerated and safe," the researchers wrote.

While IDS-CR scores declined in general, it occurred at a faster rate among the yoga participants than among those on the waitlist, Nyer and co-authors reported. There was a trend between the number of hot yoga classes and lower IDS-CR scores at week 8 when controlling for baseline score, but it wasn't significant, the researchers said.

The study was limited by the lack of an active comparator and in its generalizability, as most participants were college-educated women.

Still, Nyer and colleagues concluded that "individuals with depression can benefit from heated yoga with a relatively low practice frequency of about one class per week."

"If people are interested in the heat, feel they can tolerate it, are medically healthy, and they can access a hot yoga studio, I think a clinician could suggest this to [patients] and say there were no serious adverse effects, people got better, and it seems to work," Nyer said. "You could try it out, see how it feels for your body."

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