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A recent study demonstrated an online yoga class and a twice-daily probiotic may be an effective combined intervention for managing IBS symptoms.

Past research has linked irritable bowel syndrome (IBS) treatment to central nervous system regulation and dietary factors. Building off that body of knowledge, authors of a study published in Complementary Therapies for Clinical Practice tested probiotics’ and online yoga courses’ influence on IBS symptoms.

“The study highlights the potential of this multifaceted approach in managing IBS symptoms and enhancing overall health, emphasizing the relevance of the gut-muscle-brain axis in understanding and addressing IBS complexities,” Wei-Cheng Chao and colleagues wrote.

Multi-Component IBS Symptoms Treatment

The researchers conducted a 6-week randomized, double-blinded, and placebo-controlled study. The study team enrolled participants aged between 18 and 65 years with IBS symptoms for at least 6 months. All participants met the Rome IV Criteria for IBS. The study population included 21 women and 10 men.

The authors divided participants into three groups: one received a yoga intervention and probiotics, one completed the yoga intervention with a placebo, and one only took probiotics. The researchers recorded specific IBS symptoms before and after the intervention.

The authors used the Irritable Bowel Syndrome Quality of Life scale and the Brief Symptom Rating Scale for anxiety and depression to measure changes in mental health symptoms. They assessed physical symptoms with the International Physical Activity Questionnaire and multiple fitness tests, including a three-minute step test, sit-and-reach, sit-ups, and heart rate reserved exercise intensity. Stool samples enabled gut microbiota analyses.

Yoga and IBS

Past studies have established yoga’s benefits for treating IBS symptoms, including:

• Improved digestion due to stimulated visceral organs;
• Enhanced blood flow;
• Stronger overall digestive health;
• Decreased stress; and
• Enhanced emotional wellbeing.

The researchers developed a 40-minute online yoga routine consisting of mindfulness practices, breathwork, core exercises, and twisting exercises, as previous studies suggested these four components are effective for patients with IBS.

Participants completed this yoga class three times a week for 6 weeks. There were two to five participants per session, and all classes were hosted online. Participants wore smartwatches to measure heart rate reserve exercise intensity, with a target of 50% to 60% heart rate reserve (a low-to-moderate intensity that is safe for beginners).

After the classes, the researchers measured changes in emotional and physical symptoms. Results from the sit-and-reach test and sit-up test demonstrated no significant difference between the yoga-only group and the yoga and probiotic group. Both groups experienced a difference in the three-minute step-test, though only the yoga and probiotic group’s difference was statistically significant (P<0.01).

The yoga and probiotic group’s Irritable Bowel Syndrome Quality of Life scale scores decreased by 18 points, while the yoga-only group’s score decreased by 9.7 points. Post-intervention, there were minor decreases in the Brief Symptom Rating Scale for anxiety and depression for both groups, though these weren’t statistically significant. Participants with suicidal ideation decreased from one to zero.

Probiotics and IBS

Twenty-one participants received a probiotic, 10 of whom attended yoga classes. The remaining participants received a placebo capsule made of starch and also attended yoga classes.

The study team instructed all participants to take two capsules daily on an empty stomach for six weeks. The researchers asked participants to maintain the same lifestyle and eating habits throughout the study.

The probiotic contained multiple strains known to promote gut health, including:

• Bifidobacterium longum
• Lactobacillus acidophilus
• Lactobacillus fermentum
• Lactobacillus helveticus
• Lactobacillus paracasei
• Lactobacillus rhamnosus
• Streptococcus thermophilus

The probiotic-only group did not experience statistically significant changes on all three physical tests. This group also didn’t experience changes in the Irritable Bowel Syndrome Quality of Life scale or the Brief Symptom Rating Scale for anxiety and depression.

For the gut microbiome analysis, the probiotic-only group and the probiotic and online yoga class group exhibited differences. First, there were small changes in alpha diversity, including bacterial species and the Shannon, Simpson, and Chao 1 indices. None of these changes were statistically significant (P>0.05).

The yoga and probiotic group did show a statistically significant difference in the abundance of the Klebsiella strain, a bacteria linked to lower rates of depression. The probiotic-only group had a statistically significant difference in the abundance of prevotella, a bacteria beneficial for populations with diarrhea-predominant IBS.

Importance of Combining Treatment Options

Due to IBS’s complex nature, treatment plans that combine modalities may work better. The researchers reported that the marked changes in emotional symptoms, the gut microbiome, and the step-up test in the group who took online yoga classes, plus the probiotic, demonstrate the effectiveness of compound treatments to manage IBS.

Another significant finding is that online yoga classes were effective; this suggests regular, consistent virtual exercise programs may be impactful for patients with IBS and may be more practical than in-person classes.

“Six weeks of online yoga combined with probiotic supplementation significantly improved quality of life and reduced psychological stress in patients with IBS,” the study authors concluded. “This study validated the feasibility and effectiveness of online interventions and provided empirical support for promoting telemedicine.”