{"paper_id":"0a6837de-350a-4cff-9f4c-e65441fa6ab3","body_text":"Effect of Yoga on Quality of Life in Multiple Sclerosis Patients | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effect of Yoga on Quality of Life in Multiple Sclerosis Patients Ahmet Özşimşek, Murat Terzi, Saliha Özpınar, Sümeyye Koç, Burak Yulug This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8020087/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Studies indicate that depression and cognitive functions are important issues of mental health, a serious health issue worth evaluating with possible alternative non-medical treatment options in MS patients. Yoga, and particularly practices such as Pranayama and meditation, is an emerging complementary therapy to help with physical and mental health in MS patients. The aim of this study was to investigate the effect of practice on fatigue, respiratory closure, depression and cognition in patients diagnosed with MS and whether the benefit of yoga training is affected by personality structure. Methods: The study included 25 participants between the ages of 18–70 who were diagnosed with MS, with an EDSS of 6 and below and who did not show symptoms of depression and did not use antidepressants. Any previous cerebrovascular disease HT, DM, Trioid dysfunction, or vitamin B12 deficiency were determined as an exclusion criteria. In the study, patients received Hatha Yoga practice 2 days a week for 8 weeks. MOCA (Montreal Cognitive Assessment) and Beck Depression Scale, Personality analysis test, pulmonary function test, fatigue impact scales were applied to all patients fulfilling the inclusion criteria at the beginning and after the completion of Yoga practice. Results: According to the results obtained, a decrease in the Beck Depression Inventory results and a significant increase in the Moka Cognitive Test and respiratory capacity were detected. These findings show that yoga practice improves depression, cognitive functions and respiratory capacity. The relationship between the benefits obtained from yoga training and personality traits was evaluated by examining the participant's character and temperament inventory analysis participants character and temperament inventory analysis results. When the participants applied the personality inventory after yoga, an increase in novelty seeking, reward dependence, persistence and self-transcendence was observed. Similarly, while the participants tended to avoid harm before yoga, their tendency to avoid harm decreased after yoga. Conclusion: These findings indicate that yoga practice improves depression, cognitive functions and respiratory capacity positively ,which is also reflected in personality trait scores especially when it comes to which personality trait yoga memory depression personality breathing Background Multiple Sclerosis (MS) is a chronic autoimmune neurodegenerative disease characterized by immune-mediated damage to the myelin sheath of axons, causing the formation of plaques or lesions in the white matter of the brain and spinal cord [ 1 ]. The chronic inflammatory process produces a range of neurological deficits, including deficits in vision, balance control, and sensation. Among these, cognitive dysfunction is one of the most disabling features, affecting 34% to 91% of patients [ 2 ], and is often accompanied by a range of neuropsychiatric disturbances, including depression and anxiety (reference needed). Yoga, which originated in India over 5,000 years ago from the Sanskrit word \"yuj\" meaning “to unite,\" symbolizes the harmony of body, mind, and spirit. Hatha yoga, a traditional form, incorporates physical postures (Asanas), breathing techniques (Pranayama), and meditation (Dhyana). This holistic practice consists of eight limbs: yama (ethical conduct), niyama (self-discipline), asana (physical posture), pranayama (breath control), pratyahara (withdrawing senses), dharana (focus), dhyana (meditation), and samadhi (enlightenment) [ 3 ]. Beyond its cultural and spiritual origins, yoga has emerged as a complementary physical activity, with particular benefits for individuals with disabilities or limitations that exclude traditional exercise. Unlike static stretching, yoga involves dynamic movements coordinated with breathing, which promote physical endurance, flexibility, balance, and relaxation. More importantly, yoga also possesses psychological benefits through meditation and mindfulness exercises, which enhance proprioceptive and interoceptive awareness [ 4 ]. One of the component parts, Pranayama—the conscious regulation of breath—can be conducted at varying rates. For example, normal-speed right nostril breathing has been shown to be correlated with increased basal oxygen consumption, suggesting sympathetic nervous system stimulation, while left nostril breathing has been shown to increase galvanic skin resistance, indicating reduced sympathetic activity [ 5 ]. Pranayamic breathing, in particular, has been associated with heightened parasympathetic activity, reduced oxygen consumption, reduced heart rate and blood pressure, enhanced theta wave amplitude on EEG, and a sensation of alertness and refreshment [ 6 , 7 , 8 ]. These results suggest that Pranayama can strengthen neural plasticity and influence information processing and may thus be an efficient approach in the treatment of psychological and stress-related disorders [ 9 ]. Furthermore, yoga's influence on stress appears to downregulate both the sympathetic nervous system and the hypothalamic-pituitary-adrenal (HPA) axis, which are key contributors to depression and anxiety [ 4 ]. Such an example of the cognitive benefits of yoga includes the fact that a 60-minute yoga class was shown to improve working memory and attention, potentially by improving resting-state activity in cortico-striatal circuits, which underlie executive functions [ 10 ]. While cognitive dysfunction is an early and common manifestation of MS, respiratory dysfunction is a late manifestation of the disease and happens when demyelinating lesions affect parts of the brain that control respiration. This explains its relative low occurrence in early MS but higher incidence in late MS. Mechanisms involved include respiratory muscle weakness, bulbar dysfunction, and abnormal control of respiration [ 11 ]. This is consistent with findings that respiratory complications are responsible for approximately 47% of all MS deaths [ 12 ]. Finally, both cognitive impairment and depression are critical aspects of mental health in MS patients, and the importance of creating non-pharmacological interventions is clear. Yoga, and particularly practices such as Pranayama and meditation, is an emerging complementary therapy to help with physical and mental health in MS patients. These studies finally indicate that depression and cognitive functions are important issues of mental health, a serious health issue worth evaluating with possible alternative non-medical treatment options in MS patients. We aimed to evaluate the results of MOCA (Montreal Cognitive Assessment) and Beck Depression Scale tests administered before and after yoga training in MS patients who received 16 sessions of yoga training By examining the effect of yoga training on depression, cognition, fatigue status and respiratory function and whether yoga training is affected by personality structure we aimed to determine if provides a therapeutical advantage by modifying the personality scores of MS patients in terms of neuropsychiatric status yoga training is affected by personality structure. Methods Data collection and study population This study is an interventional research conducted to investigate the effects of yoga practice on fatigue, sleep apnea, depression, and cognition in patients diagnosed with multiple sclerosis (MS), and to examine whether the benefits of yoga training are influenced by personality traits. In the study, participants received Hatha Yoga practice 2 days a week for 8 weeks. This practice consists of three parts. The first part includes the asanas and postures of joint yoga called Pawanmuktasana, which is practiced for 20 minutes. This practice is done sitting down. Using the weight of one's own body, one has to move all the joints respectively. The second part is the breathing exercise called pranayama. In Pranayama yoga practice, holding the breath for a certain period is called Kumbhaka. With the kumbhaka practice, the person will inhale through one nostril for 4 seconds, then hold the breath for 4 seconds and exhale through the other for 8 seconds. This practice will be practiced for 15 minutes. The third part includes the practice of vippasana meditation, which in Turkish means insight meditation. This practice involves mentally scanning the whole body with breath control and will be practiced for 25 minutes. Participants section 2 In the study, patients received Hatha Yoga practice 2 days a week for 8 weeks. The study included 25 participants between the ages of 18–70 who were diagnosed with MS, with an EDSS of 6 and below and who did not show symptoms of depression and did not use antidepressants. Any previous svo disease, HT, DM, Trioid dysfunction or vitamin B12 deficiency were determined as exclusion criteria. Measurements section 3 MOCA and Beck Depression Scale, pulmonary function test, fatigue impact scale and Cloninger’s personality test were administered to the participants at baseline and after the completion of yoga training to assess depression score, cognitive status, respiratory functions, fatique status and character inventory. Beck Depression Scale: is used to determine individuals' depressive thoughts, emotional state, physical symptoms and motivation levels. Statistical Analysis section 4 Shapiro – Wilk normality tests were used to determine whether the data were normally distributed. Descriptive statistics such as numbers and percentages were used in the study, and the before-after evaluation of the scales was evaluated by analyzing with the Wilcoxon test since the data was not normally distributed. Results Participants Subject demographic and clinical data, including age, education year, MOCA scores and temperament scores, are presented in Table 1 . Participants had similar demographic characteristics in terms of age (p > 0.05) and educational level and gender (p > 0.05). Based on the according to the normal distribution of the variables, we applied either parametric (Novelty (p p < .001), Harm avoidance (p < .001)) and non-parametric tests (Reward addiction (p = 0.766), persistence (p p < .001), cooperation (p = 0.818) for the dependent and independent variables. Beck Depression Scale results Beck Depression Scale (p = 0.020) and MOCA scores were significantly improved after yoga training (p < .001, Paired Samples T-test), we also observed a statistically significant improvement in fatigue impact scale after yoga training (p < 0.001) On the other hand, while there was an improvement in pulmonary functional test, it wasn’t statistically significant. (Tables 1 )(p = 0.053) Table 1 Demographic features, multiple sclerosis duration, EDSS scores and cognitive test results of participants. multiple sclerosis Group before (n = 25) multiple sclerosis Group after (n = 25) values-value Age (Mean ± SD) 44.78 ± 8.18 44.78 ± 8.18 Education year (Median (IQR)) 8 (9.5) 8 (9.5) MOCA (Median (IQR)) 23.5(3.75) 26(3) < .001* BECK (Median (IQR)) 17(18.5) 13.5(19) 0.020* YRG (Median (IQR)) 5(6) 2(3) < .001* FVC(L) (Median (IQR)) 3.63(0.91) 3.84(0.57) 0.082 MS duration (Mean ± SD) 9.5 ± 6.47 9.5 ± 6.47 EDSS (Mean ± SD) 1.1 ± 1.3 1.1 ± 1.3 Number of attacks (Mean ± SD) 3.25 ± 1.99 3.25 ± 1.99 Gender (n, female, %) 12 12 *Based on the normal distribution of parameters, we used parametric (T test, Mean ± Standard Deviation) and non-parametric (Wilcoxon, Median (IQR) tests. We found significant difference after yoga practice regarding MOCA (p < .001), Beck depression scale (p = 0.020) and YRG (p < .001). Personality Test Results Our personality analysis test showed that baseline novelty seeking and perseverance were significantly lower compared to the normal population (p < .001, Independent T-test). At the same time, reward addiction was significantly higher compared to the normal population in terms of harm avoidance and cooperation (p < .001, Independent T-test). In this context, MS patients were predicted to be more harm-averse, cooperative and reward-dependent than the normal population, but they were observed to avoid novelty seeking. After yoga training, we observed statistically significant improvement in the mean of the temperament characters in MS patients regarding harm avoidance, persistence and novelty. (p < .001, Paired Samples T-test). Table 2 Following table shows personality traits of participants. multiple sclerosis Group before (n = 25) multiple sclerosis Group after (n = 25) p value Novelty (Mean ± SD) 13.8 ± 2.35 18.2 ± 3.17 < .001* Harm Avoidance (Mean ± SD) 21.5 ± 3.23 16.1 ± 2.59 < .001* reward addiction (Median (IQR)) 17(3) 17(2.5) 0.766 Persistence (Median (IQR)) 1(0) 2(1) < .001* Cooperation (Median (IQR)) 31(4.5) 31(5) 0.181 *Based on the normal distribution of parameters, we used parametric tests (T test, Mean ± Standard Deviation) and non-parametric (Wilcoxon, Median (IQR) tests. Novelty seeking and persistence were significantly higher after yoga practice (p < .001) Additionally, ‘harm avoidance’ among participants were significantly lower after yoga practice. Discussion In this study, we observed significant improvement in MOCA (p < 0.001) and Beck depression inventory (p = 0.020) and fatigue effect scale after 16 sessions of Yoga training for 2 months in MS patients. Our results indicate that yoga practice has a positive effect on depression, cognitive functions and fatigue. Interestingly, through temperament character inventory applied before and after yoga training, we observed statistically significant improvement in the mean of the temperament characters in MS patients, especially regarding harm avoidance, persistence, and novelty seeking. Among the altered personality scores, novelty seeking and perseverance were found lower than the normal population. In contrast, reward addiction, harm avoidance and cooperation were found to be higher than in the normal population. However, when the personality inventory was applied to the participants after yoga, an increase in novelty seeking, reward addiction, perseverance and self-transcendence was observed. Likewise, while participants tended to avoid harm before yoga, their tendency to avoid harm decreased (p < 0.001) Research on physical activity and cognition dates back to the pioneering work of Spirduso [ 13 ]. in the late 1970s, which suggested that older adults who regularly participated in physical activity had higher psychomotor speed on simple and selective reaction time tests than their sedentary counterparts. This aligns with previous evidence that mind-body therapies such as yoga that include an active attention component might provide more cognitive benefits than usual bodily movements involved in traditional forms of exercise [ 4 ]. Yoga requires a focused effort to complete the posture, control the body and breathe at a steady pace but also involves breathing (pranayama) and meditation exercises to focus on the mind and increase self-awareness. Hence, it is reasonable to assume that attention and processing speed and executive function processes showed the greatest excellent, most significant benefit from yoga practice reference according to the evidence of the positive effect of Yoga on memory processes that is comparable to the pro-cognitive effects of aerobic exercise [ 14 ]. Studies reporting the beneficial effects of Yoga on cognition have suggested several psychosocial and physiological mechanisms that may underlie the pro-cognitive effect. Here, preliminary findings suggest that the chronically overactive sympathetic nervous system and hypothalamic-pituitary-adrenal (HPA) axis can lead to the development of anxiety and depression, negatively affecting cognitive functions. Yoga has a modulating effect on the stress response and helps prevent this by reducing sympathetic nervous system activity and increasing parasympathetic nervous system activity [ 15 , 16 ]. This aligns with previous studies that similar mind-body techniques such as mindfulness-based stress reduction, transcendental meditation, and tai-chi might elicit a relaxation response through modulating the sympathetic nervous system and HPA axis activity [ 14 ]. Our findings also fit well with the beneficial role of physical activity on cognition that experiencing new activities and anaerobic interventions have unique cognitive benefits on brain structure and function [ 17 ]. From this perspective, Yoga training involving special tasks such as mind wandering, memory consolidation, introspective thinking (self-referential thinking) and incorporating the perspective of others into one's own worldview, might be associated with the modulation of the default mode network (DMN), that is active is at rest [ 18 ], and plays a critical role in executive function; working memory and a range of executive function tasks . Furthermore, the breathing and meditative practices of yoga largely parallel with self-referential thinking and involve learning and consolidation functions associated with the DMN functions. This aligns well with the role working memory involving the temporary storage, processing and manipulation of information related to a range of cognitive functions, affecting the reasoning, decision-making, learning and behaviour capacity. Although the physical and cognitive benefits associated with yoga and mindfulness may be due to activation of the parasympathetic nervous system and increased body perception [ 10 ], several studies have shown that yoga and meditation practitioners might show stronger functional connectivity in basal ganglia cortico-thalamic feedback loops and increased activation of gray matter volume and amygdala than non-practitioners [ 19 ] or which might represent a plausible explanation for improved WM after yoga [ 20 ]. For instance, several human studies suggested the beneficial effects of yoga based relaxation techniques (cyclic meditation and supine rest) on the Wechsler Memory Scale (WMS) (Forward and Backward Digit Span and several other WM task scores [ 21 ]. Another important finding of our study is significantly reduced fatigue severity scores in MS patients after Yoga. This aligns well with a recent study by Nejati et al. showing that Mindfulness-Based Stress Reduction (MBSR) and yoga programs improved fatigue (p < 0.001) and quality of life (p < 0.05) in 24 patients with MS, which also fits with the results of other studies [ 22 , 23 ]. Also our finding of improved FVC functions-despite a near-statistical significant value- might offer an alternative approach for the respiratory dysfunction that is a bad prognostic factor and depends on the specific location and extent of the demyelinating lesions in MS patients, hence occurring more frequently in terminal and later stages of MS [ 24 ]. Interestingly, we observed that improved depression scores are consistent with the anti-depressant effects of Yoga that might be associated with significant increases in serotonin levels along with decreased levels of cortisol [ 25 ]. This is in line with several studies demonstrating the potential beneficial effects of yoga interventions on depression, stress and anxiety [ 25 , 26 , 27 , 28 ]. Conclusions To conclude, our study results suggest that Yoga has a potential to improve physical, mental and emotional health. However, several limitations should be mentioned. First, the sample size is small, and further randomized with larger sample sizes are needed. Second: Restriction of working time to 2 months. Thirdly: The long-term effects could not be evaluated to evaluate the durability of this improvement. Declarations Ethics approval and consent to participate Ethical approval was obtained from the Ondokuz Mayıs University Clinical Research Ethics Committee (reference number: 223/337). The study was conducted in accordance with the principles of the Declaration of Helsinki. Consent for publication Not applicable. Competing interests The authors declare no competing interests Funding No funding was received to produce this manuscript. Author Contribution AÖ, MT, AÖ, SK and BY contributed to the study conception and design. The first draft of the manuscript was written by AÖ. and all authors commented on previous versions of the manuscript. Data analysis was performed by SÖ. All authors read and approved the final manuscript. Acknowledgements We are grateful to all the participating adolescents. Data Availability No datasets were generated or analysed during the current study References Torabi, A., Daliri, M.R. & Sabzposhan, S.H. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-8020087\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":539798984,\"identity\":\"5cb54eb4-c6d5-4733-ae06-42a045062387\",\"order_by\":0,\"name\":\"Ahmet 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16:31:23\",\"extension\":\"html\",\"order_by\":6,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"acdc-reference\",\"size\":86042,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"earlyproof.html\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8020087/v1/61261509b962a0384ac4e30b.html\"},{\"id\":95230485,\"identity\":\"8c2b929a-1b3e-49b8-ae56-909f8cdd8cab\",\"added_by\":\"auto\",\"created_at\":\"2025-11-05 16:37:36\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":572515,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8020087/v1/825393d8-8f60-482d-a5b8-04355b08031d.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"\\u003cp\\u003eEffect of Yoga on Quality of Life in Multiple Sclerosis Patients\\u003c/p\\u003e\",\"fulltext\":[{\"header\":\"Background\",\"content\":\"\\u003cp\\u003eMultiple Sclerosis (MS) is a chronic autoimmune neurodegenerative disease characterized by immune-mediated damage to the myelin sheath of axons, causing the formation of plaques or lesions in the white matter of the brain and spinal cord [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e]. The chronic inflammatory process produces a range of neurological deficits, including deficits in vision, balance control, and sensation. Among these, cognitive dysfunction is one of the most disabling features, affecting 34% to 91% of patients [\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e], and is often accompanied by a range of neuropsychiatric disturbances, including depression and anxiety (reference needed). Yoga, which originated in India over 5,000 years ago from the Sanskrit word \\\"yuj\\\" meaning \\u0026ldquo;to unite,\\\" symbolizes the harmony of body, mind, and spirit. Hatha yoga, a traditional form, incorporates physical postures (Asanas), breathing techniques (Pranayama), and meditation (Dhyana). This holistic practice consists of eight limbs: yama (ethical conduct), niyama (self-discipline), asana (physical posture), pranayama (breath control), pratyahara (withdrawing senses), dharana (focus), dhyana (meditation), and samadhi (enlightenment) [\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eBeyond its cultural and spiritual origins, yoga has emerged as a complementary physical activity, with particular benefits for individuals with disabilities or limitations that exclude traditional exercise. Unlike static stretching, yoga involves dynamic movements coordinated with breathing, which promote physical endurance, flexibility, balance, and relaxation. More importantly, yoga also possesses psychological benefits through meditation and mindfulness exercises, which enhance proprioceptive and interoceptive awareness [\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eOne of the component parts, Pranayama\\u0026mdash;the conscious regulation of breath\\u0026mdash;can be conducted at varying rates. For example, normal-speed right nostril breathing has been shown to be correlated with increased basal oxygen consumption, suggesting sympathetic nervous system stimulation, while left nostril breathing has been shown to increase galvanic skin resistance, indicating reduced sympathetic activity [\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e]. Pranayamic breathing, in particular, has been associated with heightened parasympathetic activity, reduced oxygen consumption, reduced heart rate and blood pressure, enhanced theta wave amplitude on EEG, and a sensation of alertness and refreshment [\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e]. These results suggest that Pranayama can strengthen neural plasticity and influence information processing and may thus be an efficient approach in the treatment of psychological and stress-related disorders [\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e]. Furthermore, yoga's influence on stress appears to downregulate both the sympathetic nervous system and the hypothalamic-pituitary-adrenal (HPA) axis, which are key contributors to depression and anxiety [\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eSuch an example of the cognitive benefits of yoga includes the fact that a 60-minute yoga class was shown to improve working memory and attention, potentially by improving resting-state activity in cortico-striatal circuits, which underlie executive functions [\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eWhile cognitive dysfunction is an early and common manifestation of MS, respiratory dysfunction is a late manifestation of the disease and happens when demyelinating lesions affect parts of the brain that control respiration. This explains its relative low occurrence in early MS but higher incidence in late MS. Mechanisms involved include respiratory muscle weakness, bulbar dysfunction, and abnormal control of respiration [\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e]. This is consistent with findings that respiratory complications are responsible for approximately 47% of all MS deaths [\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e]. Finally, both cognitive impairment and depression are critical aspects of mental health in MS patients, and the importance of creating non-pharmacological interventions is clear. Yoga, and particularly practices such as Pranayama and meditation, is an emerging complementary therapy to help with physical and mental health in MS patients.\\u003c/p\\u003e\\u003cp\\u003eThese studies finally indicate that depression and cognitive functions are important issues of mental health, a serious health issue worth evaluating with possible alternative non-medical treatment options in MS patients.\\u003c/p\\u003e\\u003cp\\u003eWe aimed to evaluate the results of MOCA (Montreal Cognitive Assessment) and Beck Depression Scale tests administered before and after yoga training in MS patients who received 16 sessions of yoga training By examining the effect of yoga training on depression, cognition, fatigue status and respiratory function and whether yoga training is affected by personality structure we aimed to determine if provides a therapeutical advantage by modifying the personality scores of MS patients in terms of neuropsychiatric status yoga training is affected by personality structure.\\u003c/p\\u003e\"},{\"header\":\"Methods\",\"content\":\"\\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003eData collection and study population\\u003c/h2\\u003e\\u003cp\\u003eThis study is an interventional research conducted to investigate the effects of yoga practice on fatigue, sleep apnea, depression, and cognition in patients diagnosed with multiple sclerosis (MS), and to examine whether the benefits of yoga training are influenced by personality traits.\\u003c/p\\u003e\\u003cp\\u003eIn the study, participants received Hatha Yoga practice 2 days a week for 8 weeks. This practice consists of three parts. The first part includes the asanas and postures of joint yoga called Pawanmuktasana, which is practiced for 20 minutes. This practice is done sitting down. Using the weight of one's own body, one has to move all the joints respectively. The second part is the breathing exercise called pranayama. In Pranayama yoga practice, holding the breath for a certain period is called Kumbhaka. With the kumbhaka practice, the person will inhale through one nostril for 4 seconds, then hold the breath for 4 seconds and exhale through the other for 8 seconds. This practice will be practiced for 15 minutes. The third part includes the practice of vippasana meditation, which in Turkish means insight meditation. This practice involves mentally scanning the whole body with breath control and will be practiced for 25 minutes.\\u003c/p\\u003e\\u003c/div\\u003e\\n\\u003ch3\\u003eParticipants section 2\\u003c/h3\\u003e\\n\\u003cp\\u003eIn the study, patients received Hatha Yoga practice 2 days a week for 8 weeks. The study included 25 participants between the ages of 18\\u0026ndash;70 who were diagnosed with MS, with an EDSS of 6 and below and who did not show symptoms of depression and did not use antidepressants. Any previous svo disease, HT, DM, Trioid dysfunction or vitamin B12 deficiency were determined as exclusion criteria.\\u003c/p\\u003e\\n\\u003ch3\\u003eMeasurements section 3\\u003c/h3\\u003e\\n\\u003cp\\u003eMOCA and Beck Depression Scale, pulmonary function test, fatigue impact scale and Cloninger\\u0026rsquo;s personality test were administered to the participants at baseline and after the completion of yoga training to assess depression score, cognitive status, respiratory functions, fatique status and character inventory. Beck Depression Scale: is used to determine individuals' depressive thoughts, emotional state, physical symptoms and motivation levels.\\u003c/p\\u003e\\n\\u003ch3\\u003eStatistical Analysis section 4\\u003c/h3\\u003e\\n\\u003cp\\u003eShapiro \\u0026ndash; Wilk normality tests were used to determine whether the data were normally distributed. Descriptive statistics such as numbers and percentages were used in the study, and the before-after evaluation of the scales was evaluated by analyzing with the Wilcoxon test since the data was not normally distributed.\\u003c/p\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cdiv id=\\\"Sec8\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003eParticipants\\u003c/h2\\u003e\\u003cp\\u003eSubject demographic and clinical data, including age, education year, MOCA scores and temperament scores, are presented in Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e. Participants had similar demographic characteristics in terms of age (p\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05) and educational level and gender (p\\u0026thinsp;\\u0026gt;\\u0026thinsp;0.05). Based on the according to the normal distribution of the variables, we applied either parametric (Novelty (p p\\u0026thinsp;\\u0026lt;\\u0026thinsp;.001), Harm avoidance (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;.001)) and non-parametric tests (Reward addiction (p\\u0026thinsp;=\\u0026thinsp;0.766), persistence (p p\\u0026thinsp;\\u0026lt;\\u0026thinsp;.001), cooperation (p\\u0026thinsp;=\\u0026thinsp;0.818) for the dependent and independent variables.\\u003c/p\\u003e\\u003c/div\\u003e\\n\\u003ch3\\u003eBeck Depression Scale results\\u003c/h3\\u003e\\n\\u003cp\\u003eBeck Depression Scale (p\\u0026thinsp;=\\u0026thinsp;0.020) and MOCA scores were significantly improved after yoga training (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;.001, Paired Samples T-test), we also observed a statistically significant improvement in fatigue impact scale after yoga training (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001) On the other hand, while there was an improvement in pulmonary functional test, it wasn\\u0026rsquo;t statistically significant. (Tables\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e)(p\\u0026thinsp;=\\u0026thinsp;0.053)\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003eDemographic features, multiple sclerosis duration, EDSS scores and cognitive test results of participants.\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"4\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003emultiple sclerosis Group\\u003c/p\\u003e\\u003cp\\u003ebefore\\u003c/p\\u003e\\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;25)\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003emultiple sclerosis Group\\u003c/p\\u003e\\u003cp\\u003eafter\\u003c/p\\u003e\\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;25)\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003evalues-value\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eAge\\u003c/p\\u003e\\u003cp\\u003e(Mean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e44.78\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;8.18\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e44.78\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;8.18\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eEducation year\\u003c/p\\u003e\\u003cp\\u003e(Median (IQR))\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e8 (9.5)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e8 (9.5)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eMOCA\\u003c/p\\u003e\\u003cp\\u003e(Median (IQR))\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e23.5(3.75)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e26(3)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e\\u0026lt;\\u0026thinsp;.001*\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eBECK\\u003c/p\\u003e\\u003cp\\u003e(Median (IQR))\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e17(18.5)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e13.5(19)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e0.020*\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eYRG\\u003c/p\\u003e\\u003cp\\u003e(Median (IQR))\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e5(6)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e2(3)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e\\u0026lt;\\u0026thinsp;.001*\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eFVC(L)\\u003c/p\\u003e\\u003cp\\u003e(Median (IQR))\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e3.63(0.91)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e3.84(0.57)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.082\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eMS duration\\u003c/p\\u003e\\u003cp\\u003e(Mean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e9.5\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;6.47\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e9.5\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;6.47\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eEDSS\\u003c/p\\u003e\\u003cp\\u003e(Mean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1.1\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.3\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e1.1\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.3\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eNumber of attacks\\u003c/p\\u003e\\u003cp\\u003e(Mean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e3.25\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.99\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e3.25\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.99\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eGender\\u003c/p\\u003e\\u003cp\\u003e(n, female, %)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e12\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e12\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003cp\\u003e*Based on the normal distribution of parameters, we used parametric (T test, Mean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;Standard Deviation) and non-parametric (Wilcoxon, Median (IQR) tests. We found significant difference after yoga practice regarding MOCA (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;.001), Beck depression scale (p\\u0026thinsp;=\\u0026thinsp;0.020) and YRG (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;.001).\\u003c/p\\u003e\\n\\u003ch3\\u003ePersonality Test Results\\u003c/h3\\u003e\\n\\u003cp\\u003eOur personality analysis test showed that baseline novelty seeking and perseverance were significantly lower compared to the normal population (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;.001, Independent T-test). At the same time, reward addiction was significantly higher compared to the normal population in terms of harm avoidance and cooperation (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;.001, Independent T-test). In this context, MS patients were predicted to be more harm-averse, cooperative and reward-dependent than the normal population, but they were observed to avoid novelty seeking. After yoga training, we observed statistically significant improvement in the mean of the temperament characters in MS patients regarding harm avoidance, persistence and novelty. (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;.001, Paired Samples T-test).\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003eFollowing table shows personality traits of participants.\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"4\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003emultiple sclerosis Group\\u003c/p\\u003e\\u003cp\\u003ebefore\\u003c/p\\u003e\\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;25)\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003emultiple sclerosis Group\\u003c/p\\u003e\\u003cp\\u003eafter\\u003c/p\\u003e\\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;25)\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003ep value\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eNovelty\\u003c/p\\u003e\\u003cp\\u003e(Mean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e13.8\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.35\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e18.2\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.17\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e\\u0026lt;\\u0026thinsp;.001*\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eHarm Avoidance\\u003c/p\\u003e\\u003cp\\u003e(Mean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e21.5\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.23\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e16.1\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.59\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e\\u0026lt;\\u0026thinsp;.001*\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003ereward addiction\\u003c/p\\u003e\\u003cp\\u003e(Median (IQR))\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e17(3)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e17(2.5)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.766\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003ePersistence\\u003c/p\\u003e\\u003cp\\u003e(Median (IQR))\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1(0)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e2(1)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003e\\u0026lt;\\u0026thinsp;.001*\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eCooperation\\u003c/p\\u003e\\u003cp\\u003e(Median (IQR))\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e31(4.5)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e31(5)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003e0.181\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003cp\\u003e*Based on the normal distribution of parameters, we used parametric tests (T test, Mean\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;Standard Deviation) and non-parametric (Wilcoxon, Median (IQR) tests. Novelty seeking and persistence were significantly higher after yoga practice (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;.001) Additionally, \\u0026lsquo;harm avoidance\\u0026rsquo; among participants were significantly lower after yoga practice.\\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eIn this study, we observed significant improvement in MOCA (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001) and Beck depression inventory (p\\u0026thinsp;=\\u0026thinsp;0.020) and fatigue effect scale after 16 sessions of Yoga training for 2 months in MS patients.\\u003c/p\\u003e\\u003cp\\u003eOur results indicate that yoga practice has a positive effect on depression, cognitive functions and fatigue. Interestingly, through temperament character inventory applied before and after yoga training, we observed statistically significant improvement in the mean of the temperament characters in MS patients, especially regarding harm avoidance, persistence, and novelty seeking.\\u003c/p\\u003e\\u003cp\\u003eAmong the altered personality scores, novelty seeking and perseverance were found lower than the normal population. In contrast, reward addiction, harm avoidance and cooperation were found to be higher than in the normal population. However, when the personality inventory was applied to the participants after yoga, an increase in novelty seeking, reward addiction, perseverance and self-transcendence was observed. Likewise, while participants tended to avoid harm before yoga, their tendency to avoid harm decreased (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001)\\u003c/p\\u003e\\u003cp\\u003eResearch on physical activity and cognition dates back to the pioneering work of Spirduso [\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e]. in the late 1970s, which suggested that older adults who regularly participated in physical activity had higher psychomotor speed on simple and selective reaction time tests than their sedentary counterparts. This aligns with previous evidence that mind-body therapies such as yoga that include an active attention component might provide more cognitive benefits than usual bodily movements involved in traditional forms of exercise [\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eYoga requires a focused effort to complete the posture, control the body and breathe at a steady pace but also involves breathing (pranayama) and meditation exercises to focus on the mind and increase self-awareness. Hence, it is reasonable to assume that attention and processing speed and executive function processes showed the greatest excellent, most significant benefit from yoga practice reference according to the evidence of the positive effect of Yoga on memory processes that is comparable to the pro-cognitive effects of aerobic exercise [\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eStudies reporting the beneficial effects of Yoga on cognition have suggested several psychosocial and physiological mechanisms that may underlie the pro-cognitive effect.\\u003c/p\\u003e\\u003cp\\u003eHere, preliminary findings suggest that the chronically overactive sympathetic nervous system and hypothalamic-pituitary-adrenal (HPA) axis can lead to the development of anxiety and depression, negatively affecting cognitive functions. Yoga has a modulating effect on the stress response and helps prevent this by reducing sympathetic nervous system activity and increasing parasympathetic nervous system activity [\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e]. This aligns with previous studies that similar mind-body techniques such as mindfulness-based stress reduction, transcendental meditation, and tai-chi might elicit a relaxation response through modulating the sympathetic nervous system and HPA axis activity [\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eOur findings also fit well with the beneficial role of physical activity on cognition that experiencing new activities and anaerobic interventions have unique cognitive benefits on brain structure and function [\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e]. From this perspective, Yoga training involving special tasks such as mind wandering, memory consolidation, introspective thinking (self-referential thinking) and incorporating the perspective of others into one's own worldview, might be associated with the modulation of the default mode network (DMN), that is active is at rest [\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e], and plays a critical role in executive function; working memory and a range of executive function tasks .\\u003c/p\\u003e\\u003cp\\u003eFurthermore, the breathing and meditative practices of yoga largely parallel with self-referential thinking and involve learning and consolidation functions associated with the DMN functions. This aligns well with the role working memory involving the temporary storage, processing and manipulation of information related to a range of cognitive functions, affecting the reasoning, decision-making, learning and behaviour capacity.\\u003c/p\\u003e\\u003cp\\u003eAlthough the physical and cognitive benefits associated with yoga and mindfulness may be due to activation of the parasympathetic nervous system and increased body perception [\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e], several studies have shown that yoga and meditation practitioners might show stronger functional connectivity in basal ganglia cortico-thalamic feedback loops and increased activation of gray matter volume and amygdala than non-practitioners [\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e] or which might represent a plausible explanation for improved WM after yoga [\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eFor instance, several human studies suggested the beneficial effects of yoga based relaxation techniques (cyclic meditation and supine rest) on the Wechsler Memory Scale (WMS) (Forward and Backward Digit Span and several other WM task scores [\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eAnother important finding of our study is significantly reduced fatigue severity scores in MS patients after Yoga. This aligns well with a recent study by Nejati et al. showing that Mindfulness-Based Stress Reduction (MBSR) and yoga programs improved fatigue (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001) and quality of life (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05) in 24 patients with MS, which also fits with the results of other studies [\\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eAlso our finding of improved FVC functions-despite a near-statistical significant value- might offer an alternative approach for the respiratory dysfunction that is a bad prognostic factor and depends on the specific location and extent of the demyelinating lesions in MS patients, hence occurring more frequently in terminal and later stages of MS [\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e]. Interestingly, we observed that improved depression scores are consistent with the anti-depressant effects of Yoga that might be associated with significant increases in serotonin levels along with decreased levels of cortisol [\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eThis is in line with several studies demonstrating the potential beneficial effects of yoga interventions on depression, stress and anxiety [\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR28\\\" class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e].\\u003c/p\\u003e\"},{\"header\":\"Conclusions\",\"content\":\"\\u003cp\\u003eTo conclude, our study results suggest that Yoga has a potential to improve physical, mental and emotional health. However, several limitations should be mentioned. First, the sample size is small, and further randomized with larger sample sizes are needed. Second: Restriction of working time to 2 months. Thirdly: The long-term effects could not be evaluated to evaluate the durability of this improvement.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eEthics approval and consent to participate\\u003c/strong\\u003e\\u003cp\\u003e Ethical approval was obtained from the Ondokuz Mayıs University Clinical Research Ethics Committee (reference number: 223/337). The study was conducted in accordance with the principles of the Declaration of Helsinki.\\u003c/p\\u003e\\u003c/p\\u003e\\u003cp\\u003e\\u003cstrong\\u003eConsent for publication\\u003c/strong\\u003e\\u003cp\\u003eNot applicable.\\u003c/p\\u003e\\u003c/p\\u003e\\u003cp\\u003e\\u003cstrong\\u003eCompeting interests\\u003c/strong\\u003e\\u003cp\\u003eThe authors declare no competing interests\\u003c/p\\u003e\\u003c/p\\u003e\\u003ch2\\u003eFunding\\u003c/h2\\u003e\\u003cp\\u003eNo funding was received to produce this manuscript.\\u003c/p\\u003e\\u003ch2\\u003eAuthor Contribution\\u003c/h2\\u003e\\u003cp\\u003eA\\u0026Ouml;, MT, A\\u0026Ouml;, SK and BY contributed to the study conception and design. The first draft of the manuscript was written by A\\u0026Ouml;. and all authors commented on previous versions of the manuscript. Data analysis was performed by S\\u0026Ouml;. All authors read and approved the final manuscript.\\u003c/p\\u003e\\u003ch2\\u003eAcknowledgements\\u003c/h2\\u003e\\u003cp\\u003eWe are grateful to all the participating adolescents.\\u003c/p\\u003e\\u003ch2\\u003eData Availability\\u003c/h2\\u003e\\u003cp\\u003eNo datasets were generated or analysed during the current study\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003eTorabi, A., Daliri, M.R. \\u0026amp; Sabzposhan, S.H. Diagnosis of multiple sclerosis from EEG signals using nonlinear methods. Australas Phys Eng Sci Med 40, 785\\u0026ndash;797 (2017). \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1007/s13246-017-0584-9\\u003c/span\\u003e\\u003cspan address=\\\"10.1007/s13246-017-0584-9\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eMargoni, M., Preziosa, P., Rocca, M.A. et al. Depressive symptoms, anxiety and cognitive impairment: emerging evidence in multiple sclerosis. 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[PubMed] [Google Scholar\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":true,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"yoga, memory, depression, personality, breathing\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-8020087/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-8020087/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003e\\u003cstrong\\u003eBackground:\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eStudies indicate that depression and cognitive functions are important issues of mental health, a serious health issue worth evaluating with possible alternative non-medical treatment options in MS patients. Yoga, and particularly practices such as Pranayama and meditation, is an emerging complementary therapy to help with physical and mental health in MS patients. The aim of this study was to investigate the effect of practice on fatigue, respiratory closure, depression and cognition in patients diagnosed with MS and whether the benefit of yoga training is affected by personality structure.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eMethods:\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe study included 25 participants between the ages of 18–70 who were diagnosed with MS, with an EDSS of 6 and below and who did not show symptoms of depression and did not use antidepressants. Any previous cerebrovascular disease HT, DM, Trioid dysfunction, or vitamin B12 deficiency were determined as an exclusion criteria. In the study, patients received Hatha Yoga practice 2 days a week for 8 weeks. MOCA (Montreal Cognitive Assessment) and Beck Depression Scale, Personality analysis test, pulmonary function test, fatigue impact scales were applied to all patients fulfilling the inclusion criteria at the beginning and after the completion of Yoga practice.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eResults:\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eAccording to the results obtained, a decrease in the Beck Depression Inventory results and a significant increase in the Moka Cognitive Test and respiratory capacity were detected. These findings show that yoga practice improves depression, cognitive functions and respiratory capacity. The relationship between the benefits obtained from yoga training and personality traits was evaluated by examining the participant's character and temperament inventory analysis participants character and temperament inventory analysis results. When the participants applied the personality inventory after yoga, an increase in novelty seeking, reward dependence, persistence and self-transcendence was observed. Similarly, while the participants tended to avoid harm before yoga, their tendency to avoid harm decreased after yoga.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConclusion:\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThese findings indicate that yoga practice improves depression, cognitive functions and respiratory capacity positively ,which is also reflected in personality trait scores especially when it comes to which personality trait\\u003c/p\\u003e\",\"manuscriptTitle\":\"Effect of Yoga on Quality of Life in Multiple Sclerosis Patients\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-11-05 02:26:58\",\"doi\":\"10.21203/rs.3.rs-8020087/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"49e2ef98-6989-4328-9c3d-0cfa577c54f9\",\"owner\":[],\"postedDate\":\"November 5th, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2025-12-10T16:00:43+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2025-11-05 02:26:58\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-8020087\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-8020087\",\"identity\":\"rs-8020087\",\"version\":[\"v1\"]},\"buildId\":\"8U1c8b4HqxoKbykW_rLl7\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}