Yoga as exercise or alternative medicine
Yoga class at a gym
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Yoga as exercise or alternative medicine is a modern phenomenon which has been influenced by the ancient Indian practice of Yoga. It involves holding stretches as a kind of low-impact physical exercise, and is often used for therapeutic purposes. Yoga in this sense often occurs in a class and may involve meditation, imagery, breath work and music. 
Both the meditative and the exercise components of yoga have been researched for both specific and non-specific health benefits. Yoga has been studied as an intervention for many conditions, including back pain, stress, and depression.
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.
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.
Yoga has roots in India. The foundational text for yoga is the Yoga Sutra. 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" Evangelical Christian leader Albert Mohler is a critic of yoga, saying 'the embrace of yoga is a symptom of our postmodern spiritual confusion'.
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.
Yoga and Specific Mental Health Conditions
- 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." Also, in a 2010 Boston University study it was shown that the participants who practiced yoga reported a more significant decrease in anxiety and greater improvements in mood than those who merely walked, suggesting that yoga could be a potential therapeutic activity for people with certain disorders. 
- 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).
- 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.
- Eating Disorders. In 2010 a clinical trial was conducted by doctors associated with the National Institutes of Health (NIH) to test the possible effects of yoga among adolescents receiving treatment for eating disorders. The results of the trial conveyed that the group participating in yoga showed a decrease in their disordered eating symptoms compared to the control group not participating in yoga. Examples of such symptoms include preoccupation with food, weight, and/or exercise. People struggling with eating disorders often times seek ways to control these symptoms, along with coinciding disorders such as anxiety and/or depression, by excessive exercise. With more research still to be conducted, this trial suggests that yoga may be a beneficial alternative to intense exercises that could potentially have negative weight loss effects on those individuals. 
Please consult your healthcare provider for further information before attempting any activities you are unsure about as the treatment of mental health disorders and conditions may be specific to each individual.
Yoga and Specific Physical Health Conditions
- Back pain. There is evidence that yoga may be effective in the management of chronic, but not acute, low back pain. The results of another study on the efficacy of yoga therapy for chronic low back pain showed that at around 24 weeks the yoga group had statistically significant reductions in functional disability, pain intensity, and depression compared to a standard 6-months medical treatment. It was also concluded from this study that there was a significant trend in the yoga group decreasing their use of pain medication compared that of the control group. 
- 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. In another study Dr. Debbie Cohen said "...it looks very promising that yoga might be a useful therapy for patients with mild-to-moderate hypertension who want to avoid using medication." This indicates that although yoga may not reduce higher levels of blood pressure, it is possible that it may be an effective additional practice for those with mild-to-moderate levels. 
- 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.
- Epilepsy. A Cochrane Review found no evidence to support the use of yoga in treatment of epilepsy as of 2009.
- Flexibility. Bikram Yoga is a type of yoga that incorporates a performance of 26 different positions over a general span of 90 minutes and has proven to be a factor in loosening shoulder, back and hamstring flexibility. 
- 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.
- Sexual Function. A 2009 Harvard study showed that yoga might lead to some increase in arousal, desire, orgasm and general sexual satisfaction for women. It may also improve an individual's sex life by helping them to become more familiar and comfortable with their own bodies. 
- Sports Related Physical Health. Increasingly yoga is used to train sports-persons 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.
Please consult your healthcare provider for further information before attempting any activities you are unsure about as the treatment of physical health disorders and conditions may be specific to each individual.
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 can lead to improved synchrony between mind and body. This is beneficial, he says, especially for those suffering from psychological conditions such as depression and PTSD (the focus of van der Kolk’s work), because an improved sense of connectedness between mind and body give rise to enhanced control and understanding of their "inner sensations" and state of being.
Yoga and mindfulness
Yoga is a core component of the Mindfulness-based stress reduction (MBSR) program developed by Jon Kabat-Zinn to treat patients with chronic pain. MBSR has also been applied in treating depression and borderline personality disorder as well as a host of other conditions. Mindfulness is a part of many styles of yoga, not just MBSR-based programs. 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 to improve life for people even in the absence of disease.
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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