Yog(a) as Medicine

Roli Dwivedi, MDRebecca Skoler, FNP

DISCLOSURES

• No Financial Disclosures• Our bias:

– Proponents of lifestyle medicine– Prefer to avoid medications as much a

possible– Encourage patient self-care

ObjectivesAfter taking this course, learners will be able to:

• Recognize the basic concepts of traditional yoga• Dispel common myths about yoga• Identify the evidence-based benefits of yoga• Teach basic yoga postures and breathing exercises

Yoga – History

• Originated from Veda which is ancient oldest scripture of India (4000 BC)

• Founder of yoga was Hiranyagarbha • Sage Patanjali wrote yoga sutra

around150 BC which compiles major verses including lifestyle

Traditional yoga practice “ Eight pillars of yoga” – Ashtanga

External

• Yama (Restraints) • Niyama (Observances) • Asana (Posturing) • Pranayama (Regulation of

breathing) • Pratyahara (Abstraction of senses)

Internal • Dharan ( Concentration)• Dhyan (Meditation)• Samadhi ( Self realization)

Traditional yoga practice “ Eight pillars of yoga” –advantages

• Energizes, relaxes and strengthens body and mind

• Teaches right art of living • How to deal with oneself and others • Brings peace, purity, forgiveness, truth

and consciousness

Western Yoga – Myths• Yoga is a religion• Need to be fit to do yoga• Need to be flexible to do yoga• It’s too hard for me • I’m not good at yoga

Reality is that all can access Yoga at whatever level or purpose one is seeking

Yoga - Benefits For All• Flexibility and Strength• Decreased pain• Joints - Improved range of motion• Balance• Relaxation and stress release• Peace of Mind

NHIS is an annual study in which thousands of Americans are interviewed about their health and illness related experiences. Every 5 yrs questions on complimentary health are added. The 2012 survey results are based on 34,525 adults age >.

Facts & Trends: Yoga in US in 20122012 NIH Study from Center for Complimentary and Integrative Health

• Approximately 21 million adults (nearly double the # from 2002) and 1.7 million children practiced yoga.

• Nearly 18 million adults and 927,000 children practiced meditation

• Among Americans age 18–44, yoga use nearly doubled since 2002

• Children whose parents practiced yoga were more likely to do it as well

NHIS Results• Nearly 2/3 of yoga users reported that as a result of practicing

yoga they were motivated to exercise more regularly, and 4 in 10 reported they were motivated to eat healthier, & cut back on cigarettes and alcohol

• More than 80% of yoga users reported reduced stress as a result of practicing yoga.

• While the analysis did not show why yoga users specifically reported greater wellness, more than 70 percent of yoga users reported a “focus on the whole person—mind, body and spirit” as a reason for practicing yoga

Stussman BJ, Black LI, Barnes PM, Clarke TC, Nahin RL. Wellness-related use of common complementary health approaches among adults: United States, 2012. National health statistics reports; no 85. Hyattsville, MD: National Center for Health Statistics. 2015.

Journal Article Evidence• > 1,000 scientific articles on Yoga• Effectiveness of yoga for Chronic Pain, Arthritis,

LBP, Anxiety, Depression, PTSD, IBS, Menopause, Asthma, HTN, CVD and more

• Articles in over 80 journals with range of quality• ~ 50% are controlled trials• Research remains positive but study quality is

varies, and not much replication

Evidence – Low Back Pain1. K. Williams, C. Abildso, L. Steinberg et al., “Evaluation of the

effectiveness and efficacy of Iyengar yoga therapy on chronic low back pain,” Spine, vol. 34, no. 19, pp. 2066–2076, 2009.

2. K. J. Sherman, D. C. Cherkin, R. D. Wellman et al., “A randomized trial comparing yoga, stretching, and a self-care book for chronic low back pain,” Archives of Internal Medicine, vol. 171, no. 22, pp. 2019–2026, 2011.

3. H.E.Tilbrook, H.Cox,C.E. Hewitt,et al.,“Yoga for chronic low back pain: a randomized trial,” Annals of Internal Medicine, vol. 155, no. 9, pp. 569–578, 2011.

Arthritis Review Article, 2011Rheumatoid Disease Clinics of North America, Haaz & Bartlett

• Peer-reviewed research 1980 – 2010,• 11 studies, RCT and non RTCs• All used yoga as an intervention for OA or RA, (2 did

both) and reported Qualitative findings• All trials were small – average 20 participants.• No adverse events reported and attrition rate was better

(lower) than it was for standard exercise interventions

Haaz, S. and Bartlett, S “Yoga for Arthritis: A Scoping Review. Rheum Dis Clin North Am. 2011 Feb; 37(1): 33–46.

Arthritis Review Article, 2011Rheumatoid Disease Clinics of North America, Haaz & Bartlett

Review showed evidence strongest for:1.Reduced disease symptoms (swollen joints and pain) 2.Reduced disability and improved self-efficacy and mental health

Summary of Research

• Promising but not perfect• Need more funding, larger RCT

studies that can be replicated• Need more rigor in the studies

Yoga is Important but not Serious

YOGA PRACTICEChair Yoga for you and your patients

LET’S GET STARTED – 20 MINUTE YOGA PRACTICE

Benefits – How to Access• Start with a Beginners Class• Free classes in most communities• Yoga centers offer reduced pricing/scholarships• 1,000’s of web-based resources• Favorite on-line site has 10 min – 60 min

sequences, beginner classes, classes for flexibility, chair yoga, breaking down poses

Yoga with Adriene

www.yogawithadriene.com

Simple ways to incorporate yoga in every day life

• Listen generously and be reflective• Check-in with your body • Mindful walking • Mindful driving• 3 – 5 min yoga breaks at work• Focus on the Breath

Stressed, Blessed and Yoga Obsessed.

Thank You