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Introduction |
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Yoga, derived from the Sanskrit word for "union," is a disciplined practice.
This mind-body therapy commonly refers to the use of physical postures,
breathing exercises, and meditation to improve overall well-being (Quigley and
Dean 2000). Developed several thousand years ago as part of traditional Indian
medicine, or Ayurveda, yoga has become increasingly popular worldwide and
is now practiced by a large number of Americans. |
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Historical Background |
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Yoga began in India nearly six thousand years ago. The earliest written
records documenting yoga as a health practice are recorded in The Vedas,
Indian texts dating back at least three thousand years. The physical, emotional,
and spiritual benefits of yoga are also described in other ancient texts,
including The Upanishads, The Bhagavad Gita, and The Yoga Sutras,
the latter being considered the most complete document of yogic philosophy
and teachings. However, yoga did not emerge as a fully developed practice until
500 B.C. In its traditional form, yoga is considered a complete lifestyle that
provides a path to spiritual enlightenment (Quigley and Dean 2000).
The practice of yoga came to the United States in the 1890s as a result of
the teachings of a guru named Swami Vivekananda. It gained popularity in the
1960s as a result of increasing cultural acceptance of alternative modalities
and mind-body therapies. Today, yoga is often practiced as an exercise form
divorced from its traditional spiritual underpinnings. In this form, yoga
exercise is taught at local YMCAs, health clubs, and yoga centers, and is often
part of disease prevention and management programs in hospitals, such as
stress-reduction courses for patients with hypertension and coronary heart
disease (Quigley and Dean 2000). |
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Scientific
Principles |
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Yoga is based on the idea that the flow of prana, or life energy, in
the body can be controlled and directed to induce healing and spiritual
attunement (Quigley and Dean 2000).
There are many schools of yoga, each emphasizing varying degrees of the eight
components of yogic practice: yama (restraint), niyama
(observances), asana (postures), pranayama (breath control),
pratyahara (withdrawal of the senses), dharana (concentration),
dhyana (meditation), and samadhi (supreme consciousness) (Quigley
and Dean 2000).
- Raja Yoga is called "the royal road to integration" and focuses
on meditation (Quigley and Dean 2000).
- Hatha Yoga is the most common type of yoga practiced in the
United States and focuses on yoga poses (asanas) followed by "counterposes" to
balance and integrate the body (Quigley and Dean 2000).
- Jnana Yoga emphasizes the attainment of wisdom and oneness with
God through deep contemplation and meditation (Quigley and Dean
2000).
- Karma Yoga is based on performing right actions or selfless
acts of kindness, with no expectation of reward (Quigley and Dean
2000).
- Bhakti Yoga is the practice of devotion to God (Quigley and
Dean 2000).
- Astanga, or Power Yoga, is a modern-day variation
developed for people who prefer a physically demanding workout (Quigley and Dean
2000).
- Bikram Yoga is a series of 26 asanas practiced in 105-degree
temperatures in order to warm and stretch the muscles, ligaments, and tendons,
and detoxify the body through sweat (Quigley and Dean 2000).
- Iyengar Yoga was developed by B.K.S. Iyengar, a world-famous
yoga teacher. This practice emphasizes great attention to detail, precise
alignment, and the use of props, such as blocks and belts, to facilitate the
postures (Quigley and Dean 2000).
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Mechanism of Action |
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Yoga, with its emphasis on the "union" of the total person, is considered a
form of mind-body medicine, an approach to healing that integrates and harnesses
the power of the physical, emotional, and spiritual aspects of a patient in
order to enhance health and treat illness. Physical postures, known as
asanas, provide a gentle workout that improves muscle strength,
flexibility, body alignment, and enhances circulation as well as hormone
function. Some postures are also thought to stimulate intestinal function, which
may improve digestion and relieve constipation. In addition, the relaxation
induced by yoga may help stabilize the autonomic nervous system. Although the
exact mechanism is not understood, yoga is purported to tone the internal
organs, including heart, lungs, glands, and nerves (Quigley and Dean 2000).
Yoga is also alleged to promote youthfulness and longevity. Breath control,
called pranayama, reduces oxygen consumption and blood lactate,
indicating better oxygen delivery and/or more efficient use (Quigley and Dean
2000). Yoga may also improve cardiorespiratory efficiency via decreases in heart
rate, minute ventilation, and respiratory quotient (Raju et al. 1997). As is
presumed the case with other mind-body therapies, yogic meditation elevates mood
in association with hormonal changes in the hypothalamic-pituitary-adrenal (HPA)
axis (Harte et al. 1995). Yoga also reduces blood pressure (Anand 1999) and
seems to decrease serum cholesterol, triglycerides, LDL, and the cholesterol-HDL
ratio (Mahajan et al. 1999). Furthermore, it stills the mind and induces
physical and emotional relaxation (Quigley and Dean 2000). |
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Clinical Evaluation |
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Most people learn yoga by taking a group class with an experienced
practitioner. Classes usually last from 45 to 90 minutes and begin with warm-up
exercises, proceed to a guided series of yoga postures designed to stretch and
tone all areas of the body, and end with deep relaxation and/or meditation.
Throughout the class, the teacher instructs the students on breath control
exercises and proper body alignment. |
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Clinical Applications |
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One of the major applications for yoga may be in the management of back pain
(Quigley and Dean 2000). Studies also show that yoga has immediate and long-term
benefits in decreasing anxiety and irritability, and improving
self-confidence, concentration, mental efficiency, attentiveness, optimism, and
relaxation (Malathi and Damodaran 1999). An analysis of randomized controlled
trials suggests that yoga may help manage coronary disease by helping to
decrease high blood pressure (Anand 1999), lower lipid levels in the blood
(Mahajan et al. 1999), and increase resistance to stress (Pandya et al. 1999).
Similarly, yoga exercises, breathing techniques, and meditation have been
reported to be markedly effective in reducing the frequency and severity of
angina when combined with dietary modification and stress-management training
(the Ornish program) (Quigley and Dean 2000). One study demonstrates that yoga
may be a valuable adjunctive therapy for asthma as it decreases the use of
beta-adrenergic inhalers in asthmatic subjects (Vedanthan et al. 1998).
Clinical trials for the treatment of carpal tunnel syndrome indicate that
yoga postures aimed at stretching and strengthening the joints in the upper body
can improve grip strength and Phalen sign as well as diminish pain. The
researchers concluded that yoga is more helpful than wrist splints in relieving
some symptoms and signs (Garfinkel et al. 1998).
A randomized, controlled study on osteoarthritis suggests that yoga, as a
mild form of exercise, may be effective for managing pain, improving motor
control, and enhancing range of motion (Luskin et al. 2000; Garfinkel et al.
1994). Since arthritis affects nearly fifty percent of the elderly population
and is the most prevalent chronic disease in the country, mind-body therapies
such as yoga may become valuable alternatives to pharmaceutically based
treatment (Luskin et al. 2000). |
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Risks, Side Effects, Adverse
Events |
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As with any physical activity, yoga can cause injury if practiced improperly.
To prevent injury, yoga should be practiced under the guidance of an experienced
teacher (Quigley and Dean 2000). |
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Contraindications |
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There are no known contraindications to yoga, but pregnant women and those
with chronic disease or back pain should seek the guidance of an experienced
yoga practitioner. People with chronic diseases such as arthritis, hypertension,
or cardiovascular disease should consult with their healthcare professional
before beginning a yoga practice, as they would before beginning any exercise
program. Such patients should be sure to choose a slower and gentler style of
yoga (Quigley and Dean 2000). |
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Additional Clinical
Outcomes |
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In addition to conditions already discussed, yoga may be beneficial for
adjunctive treatment of many conditions including addictions; chronic fatigue
syndrome; weight management; eye disorders such as conjunctivitis and macular
degeneration; hearing disorders; gastrointestinal disorders such as
gastritis, constipation, diverticulosis, diverticulitis, Crohn's disease,
colitis, irritable bowel syndrome, and hemorrhoids; diabetes; respiratory
disorders in addition to asthma such as emphysema, bronchitis, obstructive sleep
apnea, and even lung cancer; allergic rhinitis or sinusitis; headaches;
hyperactivity; impotence; insomnia; postpartum care; menopause; menstrual
problems such as cramps, premenstrual syndrome, and amenorrhea; endometriosis;
multiple sclerosis; rheumatoid arthritis; osteoporosis; gout; and restless leg
syndrome (Quigley and Dean 2000). |
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The Future |
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Given the impact of stress on both physical and mental health, yoga is an
important consideration for both health maintenance and adjunctive treatment of
many conditions (Apte and Kabekar 1998; La Forge 1997). Increasing focus on
disease prevention and long-term behavior change for the management of chronic
disease supports the use of yoga as part of a self-care regimen for both therapy
and prevention of conditions such as cardiovascular disease (La Forge
1997). |
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Training, Certification, and
Licensing
Requirements |
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Each yoga style or school offers teacher training and certification programs,
which include in-depth study of yoga asanas, breathing exercises, meditation,
mantras, anatomy and physiology, yogic history and philosophy, and yogic diet.
Currently, a number of practitioners from various schools are developing a
national standardized teacher certification (Quigley and Dean 2000).
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Resources |
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For general information on yoga, referral information, and a list of books,
audiotapes, and videotapes, contact the American Yoga Association in Sarasota,
Florida at 941-927-4977 or on the web at www.americanyogaassociation.org. The
Yoga Research and Education Center (YREC) in Sebastopol, California publishes
the International Journal of Yoga Therapy; for a subscription,
call 707-928-9898 or consult the web site at www.yrec.org. The YREC web site
also provides access to its clearinghouse on medical, psychological, and
scientific research on yoga, as well as general, referral, and training
information. Yoga Journal is a highly respected publication that follows
the current trends in yoga; subscriptions can be ordered by calling
800-600-9642. In addition, the Yoga Journal web site at
www.yogajournal.com lists conferences, offers books and videos, and maintains
both print and online directories of yoga teachers and training
programs. |
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References |
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Anand MP. Non-pharmacological management of essential hypertension. J
Indian Med Assoc. 1999;97(6):220-225.
Apte NK, Kabekar VG. Prevention of E.N.T. diseases. Indian J Med Sci.
1998;52(9):383-394.
Garfinkel MS, Schumacher HR Jr, Husain A, Levy M, Reshetar RA. Evaluation of
a yoga based regimen for treatment of osteoarthritis of the hands. J.
Rheumatol. 1994;21(12):2341-2343.
Garfinkel MS, Singhal A, Katz WA, Allan DA, Reshetar R, Schumacher HR Jr.
Yoga-based intervention for carpal tunnel syndrome: a randomized trial. JAMA.
1998;280(18):1601-1603.
Harte JL, Eifert GH, Smith R. The effects of running and meditation on
beta-endorphin, corticotropin-releasing hormone and cortisol in plasma, and on
mood. Biol Psychol. 1995;40(3):251-265.
La Forge R. Mind-body fitness: encouraging prospects for primary and
secondary prevention. J Cardiovascular Nurs. 1997;11(3):53-65.
Luskin FM, Newell KA, Griffith M et al. A review of mind/body therapies in
the treatment of musculoskeletal disorders with implications for the elderly.
Altern Ther Health Med. 2000;6(2):45-56.
Mahajan AS, Reddy KS, Sachdeva U. Lipid profile of coronary risk subjects
following yogic lifestyle intervention. Indian Heart J.
1999;51(1):37-40.
Malathi A, Damodaran A. Stress due to exams in medical
students—role of yoga. Indian J Physiol
Pharmacol. 1999;43(2):218-224.
Pandya DP, Vyas VH, Vyas SH. Mind-body therapy in the management and
prevention of coronary disease. Compr Ther. 1999;25(5):283-293.
Quigley D, Dean CFA. Yoga. In: Novey DW, ed. Clinician's Complete
Reference to Complementary and Alternative Medicine. St. Louis, Mo: Mosby;
2000:141-151.
Raju PS, Prasad KV, Venkata RY, Murthy KJ, Reddy MV. Influence of intensive
yoga training on physiological changes in 6 adult women: a case report. J
Altern Complement Med. 1997;3(3):291-295.
Vedanthan PK, Kesavalu LN, Murthy KC, et al. Clinical study of yoga
techniques in university students with asthma: a controlled study. Allergy
Asthma Proc.
1998;19(1):3-9. |
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Copyright © 2000 Integrative Medicine
Communications This publication contains
information relating to general principles
of medical care that should not in any event be construed as specific
instructions for individual patients. The publisher does not accept any
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The reader is advised to check product information (including package inserts)
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interactions, and contraindications before administering any drug, herb, or
supplement discussed herein. | |