Yoga as exercise or alternative medicine
Yoga class at a gym
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Yoga as exercise or alternative medicine primarily involves hatha yoga, which focuses on physical postures. Modified versions of the physical exercises in hathayoga have become popular as a kind of low-impact physical exercise, and are used for therapeutic purposes. "Yoga" in this sense and in common parlance refers primarily to the asanas but less commonly to pranayama. Aspects of meditation are sometimes included.
Both the meditative and the exercise components of yoga show promise for non-specific health benefits. According to an article in the Journal of Alternative and Complementary Medicine, the system of hatha yoga believes that prana, or healing "life energy" is absorbed into the body through the breath, and can treat a wide variety of illnesses and complaints.
A survey released in December 2008 by the US National Center for Complementary and Alternative Medicine found that yoga was the sixth most commonly used alternative therapy in the United States during 2007, with 6.1 percent of the population participating.
Background and overview
Yoga came to the attention of an educated western public in the mid 19th century along with other topics of Hindu philosophy. The first Hindu teacher to actively advocate and disseminate aspects of yoga to a western audience was Swami Vivekananda, who toured Europe and the United States in the 1890s (however, Vivekananda put little emphasis on the physical practices of Hatha Yoga in his teachings).
The physical asanas of hatha yoga have a tradition that goes back to at least the 15th century, but they were not widely practiced in India prior to the early 20th century. Hatha yoga was advocated by a number of late 19th to early 20th century gurus in India, including Tirumalai Krishnamacharya in south India, Swami Sivananda in the north, Sri Yogendra in Bombay, and Swami Kuvalayananda in Lonavala, near Bombay. In the 1960s, several of their leading students, most notably B.K.S. Iyengar, K. Pattabhi Jois, Swami Vishnu-devananda, and Swami Satchidananda became active and popular in the West. A second "yoga boom" followed in the 1980s, as Dean Ornish, MD, a medical researcher and follower of Swami Satchidananda, connected yoga to heart health, legitimizing yoga as a purely physical system of health exercises outside of counter culture or esotericism circles, and unconnected to a religious denomination.
Since then, yoga has been used as supplementary therapy for diverse conditions such as cancer, diabetes, asthma, and AIDS. The scope of medical issues where yoga is used as a complementary therapy continues to grow.
There are many different styles and disciplines and people practice yoga for a variety of reasons. Recently, research has been conducted on the healing properties of yoga and how it relates to positive psychology. Researchers wonder what psychological advantages it can afford, in addition to the previously discovered physical benefits. Yoga has proven to offer different and multiple benefits for individuals ranging from consciousness of one's body and its capabilities, satisfaction from challenging oneself physically, and increased energy and mental clarity and concentration. While the topic is still somewhat new and some research is still preliminary, results have shown significant improvements in both physical and mental health among a variety of subjects in various circumstances.
The practice of yoga traditionally includes both meditation and exercise, but in the West the focus is mainly on exercise. The more classical approaches, such as Iyengar Yoga, move at a more deliberate pace, emphasize proper alignment and execution and hold asanas for a longer time. They aim to gradually improve flexibility, balance, and strength. Other approaches, such as Ashtanga or Power Yoga, shift between asanas quickly and energetically. More recently, contemporary approaches to yoga, developed by Vanda Scaravelli and others, invite students to become their own authority in yoga practice by offering principle-based approaches to yoga that can be applied to any form.
One of the most recent trends in the practice of and research about yoga as alternative therapy is how it relates to the field of positive psychology. Positive psychology is the study of that which contributes to the overall well-being of and supports the optimal functioning of individuals. As more research is released in support of yoga contributing to a better state of being, yoga becomes more in line with positive psychology's focus on developing alternate strategies for healing and bettering individuals' lives. Positive psychology refutes the concept of dualism and scientists in this field believe that the body and mind cannot be separated. This logic indicates that all physical benefits resulting from the practice of yoga are coupled with mental benefits such as development of inner consciousness, positivity, awareness, and appreciation of nature, combining to offer a whole-body therapy. Drawing from recent research on the mental and physical benefits of practicing yoga, positive psychologists have begun to look deeper into the possibilities of utilizing yoga as a positive psychology therapy.
Yoga and religion
The most historically rooted perspective taken on yoga is that of considering yoga’s spiritual linkages and implications. The foundational text for yoga is a Hindu scripture named Yoga Sutra. The Yoga Sutra is a compilation of sutras, or concise, instructional writings. There remains controversy over when the writings were published. The Yoga Sutra is built on a foundation of Samkhya philosophy. The physical practices detailed in the Yoga Sutras are the manifestation of theory offered in the Samkhya philosophies. The sutras are divided into four parts, including:
- Samadhi Pada: translated: "On being absorbed in spirit." This section focuses on the "emergence of the spiritual man from the veils and meshes of the psychic nature."
- Sadhana Pada "On being immersed in spirit."
- Vibhuti Pada "On supernatural abilities and gifts."
- Kaivalya Pada "On absolute freedom." This final section discusses the "mechanism of salvation," referring to "the ideally simple working of cosmic law which brings the spiritual man to birth, growth and fullness of power, and prepares him for the splendid, toilsome further stages of his great journey home."
Religious articles from a variety of views and beliefs have been published to try to show that Yoga is leading people from their previous beliefs into eastern religions. Some websites are wholly dedicated to this purpose, under names such as "Yogadangers.com"
Physical aspects of yoga
Hatha yoga has become popular in the West in the last two decades, and this has resulted in a heightened profile for the physical aspect of yoga. The therapeutic benefits of yoga have been discussed by van der Kolk, who explains that because regulation of physical movement is a fundamental priority of the nervous system, focusing on and developing an awareness of physical movement allows for the mind and body to connect and be in better sync. This is beneficial for humans, especially those suffering from psychological conditions such as depression and PTSD (the focus of van der Kolk’s work) because the connectedness of mind and body allow for feelings of control and understanding of their "inner sensations" and state of being. The physical benefits of yoga are linked to the release of β-endorphins and the shift caused in neurotransmitter levels linked to emotions such as dopamine and serotonin. These benefits are most likely in high-intensity practices of yoga. Lower-intensity yoga practices, which includes a majority of yoga, typically spark the "relaxation response" as defined by Dr. Herbert Benson. This response is typified by a "physiological de-activation" of tenseness and control over one’s body. Benson related this release of control to the implicit dominance of the parasympathetic nervous system (PNS).
While much of the medical community views the results of yoga research to be significant, others argue that there were many flaws that undermine results. Much of the research on yoga has been in the form of preliminary studies or clinical trials of low methodological quality, including small sample sizes, inadequate blinding, lack of randomization, and high risk of bias. As of 2011, evidence suggests that yoga may be at least as effective at improving health outcomes as other forms of mild physical exercise when added to standard care. What is found most concerning regarding the legitimacy of yoga as a method of healing is the current lack of specificity and standardization regarding the practice of yoga. One recent study examined the difficulties of implementing yoga-based therapies and methods of healing without any detailed, standardized and vetted descriptions of the asanas promoted as being beneficial for healing. This research calls for the creation of supported intervention practices that could be distributed and applied for use in clinical practice for patients.
- Anxiety and depression. A 2010 literaure review of the research on the use of yoga for treating depression said that preliminary research suggests that yoga may be effective in the management of depression. Both the exercise and the mindfulness meditation components may be helpful. However the review cautioned that "Although results from these trials are encouraging, they should be viewed as very preliminary because the trials, as a group, suffered from substantial methodological limitations."
- Attention deficit hyperactivity disorder. A 2010 Cochrane Review concludes that there is insufficient evidence to assess the effectiveness of meditative practices such as yoga in the management or improvement of attention deficit hyperactivity disorder (ADHD).
- Back pain. There is evidence that yoga may be effective in the management of chronic, but not acute, low back pain.
- Blood pressure. Although some evidence exists to suggest yoga might help people with high blood pressure, overall this evidence is too weak for any recommendation to be made, and little is known of the safety implications of such an approach.
- Cancer. Practice of yoga may improve quality-of-life measures in cancer patients. It is unclear what aspect(s) may be beneficial or what populations should be targeted. Other studies show improvements in how participants cope with symptoms from more physical conditions, like cancer. Learning breathing and relaxation techniques help patients manage pain, depression, anxiety, insomnia, and fatigue. The patients reported that their overall quality of life significantly improved in addition to mood, distress, sleep quality, and severity of cancer symptoms. In a study performed by Susan DiStasio, women with breast cancer stated that they experienced lower pain on the day they practiced yoga, and men with prostate cancer said their stress decreased through yoga. The positive effects of yoga can be soothing to survivors as well and help them to deal with post-cancer distress.
- Dementia. A 2008 Cochrane Review concludes that the evidence was insufficient to determine whether adding mild physical activity, such as yoga, to usual care is effective in managing or improving health outcomes in patients with dementia.
- Epilepsy. A Cochrane Review found no evidence to support the use of yoga in treatment of epilepsy as of 2009.
- Menopause. Yoga has not been shown to have any specific effect for the treatment or management of symptoms of menopause.
- Pediatric conditions. A 2009 systematic review concludes that there is insufficient evidence to support the use of yoga for any indication in the pediatric population. No adverse events were reported, and most trials were positive but of low methodological quality.
- Rheumatic disease. Only weak evidence exists to support the use of yoga as a complementary therapy for helping people with rheumatic diseases, and little is known of the safety of such use.
- Sport and athletics. Increasingly yoga is used to train sportspersons and athletes, to maximize performance, improve conditioning, and minimize injury. Yoga is used extensively within British soccer to minimize injury, with Manchester United star Ryan Giggs one of the most high-profile players to publicly incorporate it in his training regime.
Although relatively safe, yoga is not risk free. Sensible precautions can usefully be taken – for example beginners should avoid advanced moves, yoga should not be combined with psychoactive drug use, and competitive yoga should be avoided.
A small percentage of yoga practitioners each year suffer physical injuries analogous to sports injuries.
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