Yoga as exercise or alternative medicine
Modified versions of the physical exercises in hatha yoga 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. New schools of yoga were introduced in the context of Hindu revivalism towards the end of the 19th century. 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.
The physical asana of hatha yoga have a tradition that goes back to 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 Sri Krishnamacharya in south India, Swami Sivananda in the north, Sri Yogendra in Bombay, and Swami Kuvalyananda in Lonavala.
In the 1960s, western interest in Hindu spirituality reached its peak, giving rise to a great number of Neo-Hindu schools specifically advocated to a western public. Among the teachers of hatha yoga who were active in the west in this period were B.K.S. Iyengar, K. Pattabhi Jois, Swami Vishnu-devananda, and Swami Satchidananda. A second "yoga boom" followed in the 1980s, as Dean Ornish, a 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. One of the main goals of yoga is to improve overall well-being through teaching discipline and self-regulation. Recently, research has focused 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 have developed (such as Vanda Scaravelli inspired, as taught by the likes of Diane Long, Sophie Hoare and Marc Woolford ) inviting students to become their own authority in yoga practice by offering principle-based approaches to yoga that can be applied to any form.
Major theoretical approaches 
Positive psychology 
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"
Mindfulness has been a fundamental aspect of yoga since its early documentation in the Yoga Sutra. Mindfulness is defined as "attending to relevant aspects of experience in a nonjudgmental manner". Mindfulness is attained through the practice of yoga in that one is able to maintain awareness of the present, releasing control and attachment of beliefs, thoughts and emotions. By letting go of one’s thoughts and mind, allowing the mind to be calm and at peace, one is able to attain a greater sense of emotional well-being and balance. Researchers have recently begun to take interest in the healing benefits of mindfulness through yoga. Research has indicated that there are health benefits of applying mindfulness-based approaches to pain management, physical functioning, and ability to cope with stresses in everyday life.
Physical aspects of yoga 
Yoga has been highly westernized in recent years, and a majority of the result of this westernization and modernization is the heightened profile of the physical aspect yoga has to offer. This physically exerting practice is typically hatha yoga, which combines asanas that exert the participant's physical self. The therapeutic healing benefits of yoga were recently discussed by van der Kolk, who posited that regulation of physical movement is a fundamental priority of the nervous system. For this reason, focusing on and developing an awareness of physical movement allows for the mind and body to connect and be in 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).
Major empirical findings 
A 2010 literature 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." At the same time, a 2009 individual study found that the regular practice of yoga helps to decrease levels of anxiety significantly. For individuals who practiced yoga twice weekly for a period of two months, levels of state anxiety and trait anxiety decreased. People also found evidence of improved mood and increased energy after an hour-long class. Evidence also indicates that yoga has some effect on lowering levels of anxiety and stress. A study on the effects of hatha yoga showed that the emphasis on breath awareness, internal centering, relaxation, and meditation enabled participants to learn to avoid mental and emotional blockages. These strategies helped participants experience lower stress and anxiety levels in addition to higher quality of life scores.
While the healing properties of yoga help individuals with clinically diagnosed anxiety and depression problems, they also help people learn to navigate and cope with daily sources of stress. A study conducted with a group of medical school students revealed lowered stress overall in addition to less stress on the mornings of exams. Significantly fewer students in the experimental group (those who received the yoga treatment) failed their exams than in the control group. Students in the experimental group said that they had a better sense of well-being, improved concentration, self-confidence, and lower levels of irritability.
More recent studies have looked into how yoga can help participants cope with symptoms from more physical conditions, such as 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. A yoga intervention program designed for overweight women showed significantly lower instances of binge-eating and higher instances of additional physical activity both during and after the intervention. Women lost weight and most became self-motivated to participate in other forms of exercise outside of the intervention.
Anxiety and depression 
The effect of yoga on symptoms of anxiety and depression is one of the most well-studied aspects of yoga's effect on the body and mind. Although researchers are optimistic about the effectiveness of yoga in alleviating depression, a 2010 review of research says that studies to date, while suggestive, are not yet conclusive. However, some research says that regular yoga practice (at least once weekly) helps to decrease levels of depression significantly. Twice weekly yoga practice for two months showed a significant decrease in levels of depression as well as levels of both state and trait anxiety. Some studies also indicate that hatha yoga has a significant effect on lowering levels of anxiety and accompanying stress. Hatha yoga encourages an increased awareness of breath, internal centering, relaxation, and meditation. These strategies helped participants experience significantly lower stress and anxiety levels in addition to higher quality of life scores.
A rigorous randomized control trial on yoga in literature comparing kundalini yoga with the relaxation response and mindfulness meditation in obsessive-compulsive disorder patients found a significant treatment difference in favor of kundalini yoga. Moreover, a 2005 systematic review of the research on yoga and anxiety presented encouraging results, particularly with anxiety-related disorders such as obsessive-compulsive disorder. Similarly, a present study assessed state anxiety, depressive mood, and subjective well-being and analyses of variance for repeated measures revealed mood improvement following yoga sessions. Other studies have shown that yoga practices reduce anxiety and depression, all the while improving well-being.
In terms of its effects on individuals in educational institutions, recent research has found that yoga benefits students, not only in reducing basal anxiety levels, but also in attenuating further increases in anxiety as they experience stressful situations like exams. Additionally, differences in mood before and after class of college students taking different courses (swimming, body conditioning, hatha yoga, fencing exercise, and lecture) were analyzed and results suggest that courses which meet four requirements involving aerobics, noncompetitiveness, predictability, and repetitiveness may reduce stress.
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). Other research shows that there is little support for yoga as treatment for ADHD alone, but it has merit as a complementary treatment to medication.
Back pain 
There is evidence that yoga may be effective in the management of chronic, but not acute, low back pain. A pilot study using a modified hatha yoga treatment showed that this was an effective treatment for chronic lower back pain, but further examination is needed specifically through studies with larger sample sizes.
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. Yoga can also help improve flexibility in cancer patients, which may allow the patients to gain confidence doing basic tasks. 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.
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.
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.
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 football to minimize injury, with Manchester United star Ryan Giggs one of the most high-profile players to publicly incorporate it in his training regime. Philipp Lahm of Germany also uses yoga. This has led to increased interest in the benefits of yoga in other sports and the rise of sports-specific yoga programs linking yoga with Sports Science, such as those developed by UK-based Yoga Sports Science.
A study conducted with a group of medical school students revealed lowered stress overall in addition to less stress on the mornings of exams. Significantly fewer students in the experimental group (those who received the yoga treatment) failed their exams than in the control group. Students in the experimental group said that they had a better sense of well-being, improved concentration, self-confidence, and lower levels of irritability.
A small percentage of yoga practitioners each year suffer physical injuries analogous to sports injuries. In regard to the practice of yoga itself, especially hatha (physically active) yoga, there are controversies over the legitimacy of "prescribing" yoga for individuals afflicted with particular conditions due to the risk of injury associated with the practice. There have been reports of yoga-related injuries and this is one reason why the practice of yoga as alternative therapy is questioned. These include carotid artery tears, bulging intervertebral discs, rotator cuff injuries, ganglion cysts, compression of the spine (vertebral column), vertebral artery dissection, and hyperextension of the neck. According to Gary Kraftsow, author of Yoga for Transformation, many asanas aren't suitable for everyone. Orthopedic surgeon Jeffrey Halbrecht, medical director for the Institute for Arthroscopy and Sports Medicine in San Francisco, warns that both experienced and novice yoga practitioners can experience injuries. "Yoga is marketed as such an innocuous thing," says Loren Fishman, assistant clinical professor of rehabilitation medicine at Columbia University in New York City. "But without care, injuries can absolutely happen." 'Strenuous' yoga has been connected to a form of stroke in young women. Practice of yoga has also been linked to causing hyperextension or rotation of the neck, which may be a precipitating factor in cervical artery dissection.
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.
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