Yoga as exercise or alternative medicine
Yoga class at a gym
Yoga as exercise or alternative medicine is a modern phenomenon which has been influenced by the ancient Indian practice of hatha 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 hatha yoga have been researched for both specific and non-specific health benefits. Hatha yoga has been studied as an intervention for many conditions, including back pain, stress, and depression. In general, it can help improve quality of life, but does not treat disease.
A survey released in December 2008 by the US National Center for Complementary and Integrative Health found that hatha 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 1918, Pierre Bernard, the first famous American yogi, opened the Clarkstown Country Club, a controversial retreat center for well-to-do yoga students, in New York State. In the 1960s, several yoga teachers, most notably B.K.S. Iyengar, K. Pattabhi Jois, Swami Vishnu-devananda, and Swami Satchidananda became active and popular in the West. A hatha "yoga boom" followed in the 1980s, as Dean Ornish, MD, a medical researcher and follower of Swami Satchidananda, connected hatha yoga to heart health, legitimizing hatha 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 of hatha yoga, 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 Hatha Yoga research to be significant, others argue that there were many flaws that undermine results. Much of the research on Hatha 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 Hatha 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 Hatha Yoga as a method of healing is the current lack of specificity and standardization regarding the practice of Hatha Yoga. One recent study examined the difficulties of implementing Hatha 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.
Hatha Yoga and Specific Mental Health Conditions
- Anxiety and depression. A 2010 literature review of the research on the use of Hatha Yoga for treating depression said that preliminary research suggests that Hatha 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. No benefit.
- Dementia. There is some evidence that exercise programs may help people with dementia perform their daily activities.
Hatha Yoga and Specific Physical Health Conditions
- Back pain. There is evidence that Hatha Yoga may be effective in the management of chronic, but not acute, low back pain. The results of another study on the efficacy of Hatha Yoga therapy for chronic low back pain showed that at around 24 weeks the Hatha 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 Hatha Yoga group decreasing their use of pain medication compared that of the control group.
- Blood pressure. Although some evidence exists to suggest Hatha 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 Hatha 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. Hatha Yoga practice as part of cancer treatment has also shown improvement in biomarkers such as TNF-alpha, Interleukin 6 and IL-1beta. Stronger effects on biomarkers as well as quality-of-life measures is associated with more frequent Hatha Yoga practice. Hatha Yoga has no effect on the underlying disease.
- Epilepsy. No benefit.
- Menopause-related symptoms. No benefit.
- Pediatric conditions. A 2009 systematic review concludes that there is insufficient evidence to support the use of Hatha 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 Hatha Yoga as a complementary therapy for helping people with rheumatic diseases, and little is known of the safety of such use.
- Sports Related Physical Health. Increasingly Hatha Yoga is used to train sports-persons and athletes, to maximize performance, improve conditioning, and minimize injury. Hatha 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.
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.
Hatha Yoga and mindfulness
Yoga is a core component of the Mindfulness-based stress reduction (MBSR) program. 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, Hatha Yoga is not risk free. Sensible precautions can usefully be taken – for example beginners should avoid advanced moves, Hatha Yoga should not be combined with psychoactive drug use, and competitive Hatha Yoga should be avoided.
When using Hatha Yoga as a treatment, patients should inform the teacher of their physical limitations and concerns. Functional limitations should be taken into consideration. Modifications can then be made using props, altering the duration or poses.
A small percentage of Hatha Yoga practitioners each year suffer physical injuries analogous to sports injuries.
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