excessive exercise beyond an appropriate intensity or duration has negative effects on the 
 human body1,2,3,4 and causes an imbalance between reactive oxygen species ( ros ) and 
 antioxidant enzymes .
because of this imbalance , biological structures , membranes , and dna 
 are damaged , and malondialdehyde ( mda ) , the final product of lipid peroxidation , 
 increases5 .
increases in ros and free 
 radical levels6 , 7 accelerate aging , as indicated by a decrease in telomere length8 , 9 and 
 contribute to the development of various diseases including cancer and genetic diseases 
 related to gene mutations10 , 11 .
stocker et al.12 found that when ros are 
 generated after high - intensity exercise , the human body activates antioxidant enzymes in 
 response , as a protective function13 , 14 , and to ensure hemostasis15 , 16 .
superoxide dismutase ( sod ) is a key detoxification enzyme among the 
 antioxidant enzymes .
sod removes ros by catalyzing and transforming superoxide into two 
 non - toxic substances , and is frequently monitored and measured as an indicator of oxidative 
 stress17,18,19 .
lee et al.20 have reported that yoga 
 exercise can be used to treat body composition and serum lipid profiles .
previous studies 
 have shown that breathing exercises undertaken during yoga reduce the prevalence of many 
 pathogens by decreasing free radicals .
these exercises improve antioxidant responses during 
 musculoskeletal activities in elderly subjects and pregnant women by improving the oxygen 
 supply to various tissues with minimal exertion .
in addition , sinha et al.21 reported that yoga exercises , performed 
 over a period of six months , increased antioxidant enzyme concentrations in the body of 
 healthy adult men .
another study showed that yoga exercises performed over a period of 16 
 weeks increased antioxidant enzyme activities , decreased lipid peroxidation , and improved 
 stamina22 .
however , to date , no 
 published review has evaluated the impact of yoga exercise on reactive oxygen species and 
 antioxidant enzymes .
therefore , we investigated the effects of hatha yoga exercise on plasma 
 malondialdehyde concentration and superoxide dismutase activity .
our subjects were females 
 in their twenties with shoulder pain , who performed hatha yoga three times weekly for 16 
 weeks .
ten females , in their twenties , were included in our study as the exercise group .
all had 
 shoulder pain , based on medical examination , physician interview , and physical examination . 

the control group was composed of ten females in their twenties with similar shoulder pain . 

body composition was measured prior to the experiment , and the hatha yoga exercise group 
 engaged in preliminary exercise for one week prior to beginning the yoga program to adapt . 

the yoga exercises consisted of a five  min warm - up , 40  min of main exercise , and a five  min 
 cool down , for a total duration of 50  min ( table 
 2table 2.modified hatha yoga exercise programweekexercise ( type)duration 116warm - up ( 5 min)neck rolls , shoulder circles , ankle circles , stretching 
 exercisesmain exercise ( 40 min)1 .
matsyasana2 min2 setscool - down ( 10 min)savasana , lying leg swinging , relaxation , nadishodhna ) .
all participants provided 
 their written informed consent prior to participation , and ethical approval was granted by 
 our institutional human research committee . to analyze plasma mda concentrations ,
blood was collected in edta - treated vacutainer tubes 
 ( lavender tube ) and centrifuged .
plasma mda concentration analysis was conducted using a colorimetric 
 method in a hp8452a spectrophotometer ( hi - tech scientific , usa ) using a bioxytech lpo-586 
 kit ( oxis biotech , tampa , fl , usa ) . to analyze plasma sod activity ,
blood was collected in edta - treated vacutainer tubes 
 ( lavender tube ) and centrifuged .
the reagent was prepared with tetrazolium in order to measure the 
 superoxide radical , which is generated by xanthine and xanthine oxidase using an ibl kit 
 ( ibl international , hamburg , germany ) .
all data are presented as mean  sd , and all statistical analyses were completed using spss 
 version 21.0 for windows ( spss inc . ,
changes from baseline to the end of the intervention were 
 determined using the paired t - test and the independent t - test .
all the participants characteristics and percent body fat were measured before the start 
 and at the end of the 16-week exercise - training program .
there were no significant 
 differences in baseline demographic characteristics between the study groups ( table 1table 1.descriptive characteristics of the study participantsyoga exercise(n=10)control(n=10)age ( yrs)22.4  2.422.5  1.4height ( cm)161.0  4.5160.5  6.2weight ( kg)50.8 
. tables 3table 3.changes in mda after 16-week hatha yoga exercise within each grouppre - testpost - testyoga exercise ( n=10)4.02  0.253.78  0.27*control ( n=10)3.59  0.205.43  0.19**p < 0.05 and 4table 4.changes in sod after 16-week hatha yoga exercise within each grouppre - testpost - testyoga exercise ( n=10)7.58  0.2711.10  0.58*control ( n=10)7.56  0.356.95  0.32*p
< 0.05 show that the baseline values between the two groups were comparable for 
 plasma mda concentration and sod activity .
hatha yoga exercise training resulted in a 
 significant decrease in plasma mda concentration ( p < 0.05 ) and a significant increase in 
 plasma sod activity ( p < 0.05 ) .
the control group showed an increase in plasma 
 malondialdehyde ( mda ) concentration and decrease in plasma sod at the end of the 16 
 weeks .
meydani et al.6 reported that conjugated 
 dienes of skeletal muscle increased after running exercise ( 75% of maximum heart rate , 
 15  min , 3 times ) .
also , a recent study of patients with chronic obstructive pulmonary 
 disease ( copd ) and healthy subjects demonstrated that lipid peroxidation was higher in the 
 vastus lateralis muscle ( vlm ) than at rest and 48 hours after performing knee extension 
 exercises until exhaustion in the copd subjects .
the degree of oxidation is determined by exercise type , intensity , and duration23 , 24 .
lipid peroxidation generated by active oxygen and ros is caused by 
 the oxidation of polyunsaturated fatty acid , which is the main ingredient of biological 
 membranes .
prolonged aerobic activities and low - intensity exercise require more energy than being at 
 rest , therefore the supply of oxygen to active tissues increases considerably .
an increase 
 in maximal oxygen uptake through exercise is closely related to respiratory health .
several 
 researchers have indicated that the formation of free radicals is mainly the result of 
 muscle damage and fatigue induced by exercise . in the present study , a significant difference was found in the plasma mda concentration 
 between the two groups ( p < 0.05 ) . in the control group ,
the mda concentration increased 
 significantly after 16 weeks ( p < 0.05 ) , whereas in the exercise group , there was no 
 significant difference during the various stages of exercise , but levels were highest 
 immediately after exercise .
this result is consistent with that of a previous study which showed that respiration of 
 mitochondria increased with exercise intensity .
exercise caused the production of oxygen 
 free radicals that increased oxidative stress , causing increased tissue damage and lipid 
 peroxidation .
this was because mda decreased after the one - off training exercise induced 
 oxidative stress , thereby causing an increase in lipid peroxidation .
long - term aerobic 
 training can increase the antioxidant capability of the human body , thereby helping to 
 maintain the oxidation - reduction balance25 .
ros generated through exercise play an important role in damaging to oxidized fragments in 
 main tissues , and excessive endogenous oxidants can damage to tissues through enzyme 
 inactivation , lipid peroxidation , and dna damage .
however , antioxidant enzymes [ e.g. , sod , 
 catalase ( cat ) , and gsh peroxidase ( gpx ) ] that protect the human body from oxidative damage 
 can catalyze electron - reduction reactions of ros . among these , sod is the most widely 
 measured as an index of oxidative stress .
many studies have reported that sod activity in 
 skeletal muscles increases significantly after exercise . however , many studies have failed 
 to accurately determine the exercise adaptation pattern of sod , despite using similar animal 
 exercise models .
powers et al.26 
 investigated the effect of intensity and duration of exercise and muscle fiber types on sod 
 activity in mice .
an increase in sod activity was observed in the gastrocnemius muscle of 
 mice who had engaged in only high - intensity exercise .
however , exercise adaptation was more 
 significant in the soleus muscle , with an increase in sod activity in response to exercise 
 duration rather than exercise intensity . in the present study , there was a significant difference in plasma sod activity between the 
 two groups ( p < 0.05 ) . in the control group
it decreased significantly ( p < 0.05 ) , 
 whereas in the exercise group it increased significantly ( p < 0.05 ) .
this result is 
 consistent with a previous study in which antioxidant enzyme activity increased after 
 exercise .
this also supports the results of a previous study in which a yoga exercise 
 program that required minimum energy consumption was shown to increase antioxidant 
 capability .
the results of that study indicate that yoga exercise over a period of 12 weeks 
 decreased plasma mda concentration , reflecting decreased ros levels , and increased plasma 
 sod activity , reflecting reduced oxidative stress .
hatha yoga exercise offers health 
 benefits through improvement of flexibility , muscle tone and strength , balance , lung 
 capacity , and joint function .
moreover , meditation and breathing techniques inhibit ros 
 generation and have a positive effect on antioxidant capacity by reducing stress hormones 
 and indicators of muscle damage .
our findings indicate that regular and continuous modified 
 hatha yoga exercise would effectively improve body composition , decrease plasma mda 
 concentration , and increase plasma sod activity in female patients with shoulder pain
. 
 therefore , hatha yoga exercise should be effective at preventing shoulder pain due to 
 various causes in female patients with skeletal muscle pain syndrome .
 [ purpose ] the purpose of this study was to analyze the effects of hatha yoga exercise on 
 plasma malondialdehyde ( mda ) concentration and superoxide dismutase ( sod ) activity in 
 female patients with shoulder pain . 
 [ subjects ] subjects comprised 20 female patients with 
 shoulder pain . [ methods ] subjects were divided into 2 groups : a hatha yoga exercise group 
 ( n = 10 ) and a control group that performed no exercise ( n = 10 ) . 
 the subjects body 
 composition , plasma malondialdehyde concentrations , and superoxide dismutase activities 
 were measured before and after a 16-week hatha yoga exercise program . 
 [ results ] after the 
 16-week hatha yoga exercise program , the exercise group had significantly lower plasma mda 
 concentrations than the control group . 
 in addition , the exercise group had significantly 
 higher plasma sod activity than the control group . 
 [ conclusions ] hatha yoga exercise 
 improves flexibility , muscle tone and strength , balance , and joint function . our findings 
 indicate that regular and continuous yoga exercise effectively improved body composition , 
 decrease plasma mda concentration , and increase plasma sod activity in female patients 
 with shoulder pain . 
INTRODUCTION
SUBJECTS AND METHODS
RESULTS
DISCUSSION