Yoga as an Intervention for Tobacco Cessation - A Randomized Controlled Trial

Background: Current management strategies for tobacco cessation including pharmacological interventions, cognitive behavioural therapy (CBT), and other supportive therapies have limitations. Emerging evidence suggests that alternate therapies, particularly yoga, may play a significant role. This study was undertaken to evaluate the role of yoga for tobacco cessation in adult tobacco users. Methods: A prospective randomized, open, blinded end-point trial was conducted among healthy adult tobacco users aged 18-65 years. Participants were randomly assigned in a 1:1 allocation ratio to either yoga (n=64) or exercise (n=66), using stratified block randomisation. The primary outcome measure was 7-day Point Prevalence Abstinence (7-PPA) validated by salivarycotinine levels, at 6 months. Secondary outcomes included Quality of Life (QoL), assessed using the World Health Organization Quality of Life-brief (WHOQOL-BREF), and psychological health outcomes using the Depression, Anxiety and Stress Scale (DASS) at 6 months. Findings: Between December 2021 to June 2023, 910 adult tobacco users were screened. A total of 130 eligible participants (96.9%male) were included, of which 51 (39.3%) were smoking and 79 (60.7%) were smokeless tobacco users. At the final follow-up, 14 (22%) participants in the yoga group achieved 7-PPA, compared to 6 (9.1%) participants in the exercise group,(p = .043) (OR: 2.8, 95% CI:1.04-8.40). There were significant improvements in quality of life (p < .05), and psychological health outcomes, with reductions in stress and anxiety (p < .001),and depression (p = .008), between the groups at the final follow up. Interpretation: Yoga was found to be more effective than exercise in achieving tobacco abstinence, among both smoking and smokeless tobacco users, along with improvements in quality of life andpsychological health outcomes.