A new study in the Journal of Alternative and Complementary Medicine (July 2015) reports that there is surge in clinical research on yoga for certain illnesses and medical conditions. The researched examined articles published between 1967 and 2013 and found 486 articles published in 217 different peer-reviewed journals from 29 countries.
About half of clinical studies of yoga (45%) were randomized controlled trials, which are considered the highest level of clinical evidence. The top three diseases studied with yoga were mental health, cardiovascular disease, and respiratory disease (like asthma).
Clinical research of yoga, however, continues to face challenges. There are also significant limitations in funding, time, and resources. Researchers often use different types of yoga (often not specified), lengths of study, and frequency of practice. Studies also draw from a variety of yoga breathing, postures, and meditation. Standardization would help advance and clarify the role of yoga in treatment.
With one in ten Americans practicing yoga and nearly half (45%) of Americans saying that they are interested in doing yoga, now is the time to examine the healing role of yoga. More high-quality, evidence-based research will help us know how best to integrate yoga into the medical treatment of illnesses.
Even though yoga practiced in the West has been focused more on the postures (or asanas), yoga philosophy is rooted in the development of meaning and purpose. Here are fives ways yoga helps us gain a sense of fulfillment.
1. Research shows that the practice of yoga can help you achieve a more meaningful and grounded sense of well-being.
The ancient practice describes four purusharthas, or fundamental concepts that guide meaning in your life. Yoga has four central purposes:
- dharma (virtue or duty in one’s life purpose),
- artha (prosperity or the creation of a balanced life),
- kama (joy and pleasure), and
- moksha (freedom).
2. Priorities can compete with each other-- yoga acknowledges this complexity.
Sometimes priorities compete with each other– like when you’re having to sacrifice spending time with family (kama) in order to meet a deadline and work late at the office (dharma) or when you have to take a job that you are less passionate about in order to be financial stable. It’s important to find the balance that works for you.
3. Yoga helps you become more self-aware.
Awareness is key so that you can balance your different goals, especially since our needs and priorities are constantly shifting. Becoming in tune with yourself and your direction helps you avoid burnout or detachment.
4. Yoga increases empathy and feelings of compassion, gratitude, and respect.
Yoga has been shown to increase empathy and bring greater feelings of compassion, gratitude, and respect. One study of 124 individuals who practiced yoga at least two times a week found that the extent of yoga experience positively correlated with both more meaning in life and feelings of gratitude. The results suggested that the more you practice yoga, the more you gained a sense of happiness and purpose.
5. Yoga allows us to be fully aware of the entire range of our emotional experiences and to accept them as they are.
Several other studies have shown that more frequently you practice yoga, the more you experience positive emotions, higher satisfaction in life, joy, energy, improved quality of life and greater sense of well-being.
A core component of yoga is not to struggle with the past or plan for the future but to be present in the moment as it exists now. At its heart, yoga acknowledges that our life has experiences that range from happiness to frustration to suffering-- that's allowed. Practicing yoga regularly helps us explore where we are at rather than struggle with where we are not. We can then give ourselves the space to connect to a deeper sense of meaning and find balance that extends beyond the mat.
Impett, E.A., Daubenmier, J.J., Hirschman, L., 2006. Minding the body: yoga embodiment and well-being. Sex. Res. Soc. Null. Kournal NSRC 3 (4), 39e48.
Ivtzan I, Papantoniou A. Yoga meets positive psychology: Examining the integration of hedonic (gratitude) and eudaimonic (meaning) wellbeing in relation to the extent of yoga practice. Journal of Bodywork & Movement Therapies (2014) 18, 183e189.
Radford, M.A., 2000. Turning the heart inside-out: the vision of reality according to Kashmir aivism and Vajrayana. Human. Soc. Sci. 61 (5-A), 1899.
Walsh, R., 2001. Positive psychology: east and West. Am. Psychol. 56 (1), 83e84.
Restorative yoga is a style of yoga that uses props such as bolsters, blankets, and blocks to help support poses for extended periods of times (for 8-10 minutes or at times longer). The practice is helpful to release tension in muscles, reduce stress, and is readily accessible for yogis of all levels of experience. The practice does not include a rigorous flow or balancing sequence and is not intended to be a strenuous "workout."
However, routine restorative yoga practice has been linked with both weight loss and reduction in subcutaneous fat. A study led by Maria G. Araneta, PhD, MPH, of the University of California, San Diego examined whether a 48-week restorative yoga program could help reduce body fat and help with weight loss in overweight women. They found that over the 6 months of restorative yoga practice, the 88 women in the yoga group had significantly more weight loss (2.9 lbs) compared to the 83 women practicing stretching exercises who lost on average 1.5 lbs-- a weight loss that was maintained at 48 weeks.
At six months, the women who practiced restorative yoga also had a pronounced difference in subcutaneous fat reduction compared to the stretching group (31 square centimeters reduction compared to 12 square centimeters). Unlike the stretching group, the restorative yoga group maintained this reduction in body fat at the 48 week mark. One potential explanation is that restorative yoga is able to reduce stress by lowering cortisol levels, a stress hormone known to increase abdominal fat.
This study offers promising results for those interested in practicing an accessible and stress-reducing form of yoga.
More information available here.
Neurocardiogenic syncope (NCS) is a common condition in which abrupt cardiovascular autonomic changes (e.g., heart rate, blood pressure) can result in syncope (fainting). Yoga has been shown in long-term yoga practitioners to improve autonomic variability and the stability of the autonomic nervous system response to stress.
A pilot study of 44 primarily young women (21 in intervention group; 23 in control group) with neurocardiogenic syncope found that yoga practice three times a week for 3 consecutive months significantly improved number of episodes of syncope and functional status. All the subjects before yoga intervention had a positive tilt table test (meaning that lightheadedness or fainting was triggered by raising the head to 60 or 80 degrees) and only 6 of the 21 subjects had a positive test after the three-month yoga intervention. The study suggests that yoga could be helpful for yoga women who have neurocardiogenic syncope, and further research and larger studies are warranted.
A survey of 2508 yoga class attendees and 271 yoga therapists in Japan (released March 2015 in BioPsychoSocial Medicine) found that nearly 30% of attendees experienced an adverse event (defined as a "undesirable symptoms or responses that occurred during a yoga class") during class.
Over half of the yoga class attendees (53.5%) had chronic diseases and 1063 (42.3%) were being prescribed medications at hospitals. In terms of age, 36.5% of the class participants were in their 60s and 16.3% in their 70s.Read More
Chronic pain can lead to physical and mental consequences beyond the pain. Up to 50% of patients with long-term chronic pain can experience mood issues including anxiety and depression. Chronic pain can also impair concentration, attention, and memory, even after controlling for mood symptoms, which suggests that pain impacts cognition.
Chronic pain has been associated with structural changes in the brain. Structural magnetic resonance imaging studies (MRIs) of chronic pain patients have shown a decrease in gray matter in areas of the prefrontal cortex, insula, and anterior and midcingulate cortices-- areas associated with pain processing, regulation of mood, and cognition. It is unclear whether these brain differences are the cause or effect of chronic pain.
A recent review in Pain (April 2015) discusses the growing literature to support that mind-body practices like meditation and yoga can improve chronic pain and its negative impact on the body and mind. Several studies have shown that both experienced and beginner mind-body practitioners experience less pain when exposed to painful stimuli-- both during and outside of meditative states. Experienced yoga practitioners as well as short-term mindfulness practices have been shown to have increased ability to tolerate cold pain. Yoga has also been shown to improve conditions associated with chronic pain, including depression, anxiety, and fatigue.
There is also growing evidence that suggests the protective effects of yoga on the brain (both gray and white matter).
Yoga and meditation have also been associated with changes in the brain that appear to counter age-related decline in gray matter volume. Experienced yogis and meditators have more gray matter volume and cortical thickness in brain regions that are involved in pain processing, attention, autonomic control, and emotion regulation (including primary and secondary somatosensory cortices, insula, anterior and posterior cingulate cortices, superior and inferior parietal cortices, hippocampus, and medial prefrontal and orbitofrontal cortices). Yoga and meditation practitioners have also been found to have increased white matter connectivity throughout the entire brain (in contrast, chronic pain is associated with disrupted white matter connectivity). Even a short term intervention of 11 hours of meditation has been associated with white matter changes in areas associated with self-regulation (i.e., changes to the corona radiata, a white matter tract).
Chronic pain is challenging both because of the pain itself as well as the long-term impairment of mood and cognition. Yoga and meditation-- even short-term beginner practices-- can be effective non-pharmacological interventions to counter the long-term negative effects of chronic pain on the body, brain, and mind.
Bushnell MC, Case LK, Ceko M, Cotton VA, Gracely JL, Low LA, Pitcher MH, Villemure C. Effect of environment on the long-term consequences of chronic pain. Pain. 2015 Apr;156 Suppl 1:S42-9. doi: 10.1097/01.j.pain.0000460347.77341.bd.
Yoga & Pregnancy
A recent study published in Women's Health Issues found that a 10-week gentle prenatal yoga program for 34 pregnant women with depression significantly improved the severity of depression. Yoga helped improve depression severity in both observed measures as well as subjective self-report. No injuries or safety issues were reported during the program. This study adds to the existing literature that gentle prenatal yoga can help treat depression and has advantages especially for women who prefer to minimize medications during pregnancy.
Battle CL, Uebelacker LA, Magee SR, Sutton KA, Miller IW. Potential for prenatal yoga to serve as an intervention to treat depression during pregnancy. Womens Health Issues. 2015 Mar-Apr;25(2):134-41. doi: 10.1016/j.whi.2014.12.003.
Yoga & Body
Yoga has also been shown to improve joint range of motion in people with osteoarthritis. A randomized controlled trial of 250 people with osteoarthritis of the knees compared 40 minutes of daily Hatha yoga exercises to therapeutic exercises over 3 months and found that yoga significantly improved range of knee flexion more than non-yoga therapeutic exercises at both the Day 15 and Day 90.
So don’t let your fear of being “inflexible” stop you from trying a safe, supervised yoga practice. Yoga is not a competition or a quest to find the “perfect” pose, but the union of the body and mind to find a centering practice that is safe and healthy for your unique and individual body and mind. There is no one-size-fits-all yoga pose sequence. Many poses and sequences can be modified safely with the support of blocks, blankets, or alternative positions. The key is talk openly to your yoga teacher about concerning areas of tightness or injury ahead of class and not to push yourself past your own limit.
If you have injuries or medical conditions, please check with your physician first to ensure a safe yoga practice. Pregnant women should practice sequences modified for prenatal yoga and should consult with their physician.
People often say, “I can’t do yoga because I’m not flexible enough.” This is like saying “I don’t lift weights because I’m not strong enough.” A safe practice of yoga can actually increase flexibility.
A February 2015 study in Journal of Physical Therapy Science found that 90 minutes of Hatha Yoga per week for 20 weeks increased spinal flexibility in women over 50 years old. The study found that yoga practice increased spinal mobility, hamstring flexibility, and joint range of motion in all age groups. Previous studies have similarly shown an increase in muscular strength, endurance, and joint range of motion even from 8 weeks of twice a week yoga practice of 10 minutes of pranayamas (breath-control exercises), 15 minutes of dynamic warm-up exercises, 50 minutes of asanas (yoga postures), and 10 minutes of supine relaxation in savasana (corpse pose).
Note: People with a history of medical conditions such as osteopenia or osteoporosis (low bone mineral density), bone or cartilage disorders, should speak to their physicians first as well as yoga teachers to find out guidelines for a safe practice to prevent any injuries from excessive force or pressures on the body during practice. Depending on the individual, certain poses should be modified or avoided.
Grabara M, Szopa J. Effects of hatha yoga exercises on spine flexibility in women over 50 years old. J Phys Ther Sci. 2015 Feb;27(2):361-5. doi: 10.1589/jpts.27.361. Epub 2015 Feb 17.
Tran MD, Holly RG, Lashbrook J, Amsterdam EA. Effects of Hatha Yoga Practice on the Health-Related Aspects of Physical Fitness. Prev Cardiol. 2001 Autumn;4(4):165-170.
Ebnezar J, Nagarathna R, Yogitha B, Nagendra HR. Effects of an integrated approach of hatha yoga therapy on functional disability, pain, and flexibility in osteoarthritis of the knee joint: a randomized controlled study. J Altern Complement Med. 2012 May;18(5):463-72. doi: 10.1089/acm.2010.0320. Epub 2012 Apr 26.
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