Several recent reports and studies have shed light on the positive health benefits of yoga. Interestingly though, there have also been a few reports detailing some down sides as well.
Heart disease patients who practice yoga in addition to aerobic exercise saw twice the reduction in blood pressure, body mass index and cholesterol levels when compared to patients who practiced either Indian yoga – a combination of whole exercise of body, mind and soul, and a common practice throughout India – or aerobic exercise alone, according to research presented recently at the 8th Emirates Cardiac Society Congress in collaboration with the American College of Cardiology Middle East Conference.
Researchers in this study looked specifically at Indian yoga and aerobic training’s effect on the coronary risk factors of obese heart disease patients with type 2 diabetes. Lifestyle intervention has been shown to aid in reducing the co-occurring risk of death and heart disease when used alongside medical management.
Combing Yoga And Aerobic Exercise
The study looked at 750 patients who had previously been diagnosed with coronary heart disease. One group of 225 patients participated in aerobic exercise, another group of 240 patients participated in Indian yoga, and a third group of 285 participated in both yoga and aerobic exercise. Each group did three, six-month sessions of yoga and/or aerobic exercise.
The aerobic exercise only and yoga only groups showed similar reductions in blood pressure, total cholesterol, triglycerides, LDL, weight and waist circumference. However, the combined yoga and aerobic exercise group showed a two times greater reduction compared to the other groups. They also showed significant improvement in left ventricular ejection fraction, diastolic function and exercise capacity.
“Combined Indian yoga and aerobic exercise reduce mental, physical and vascular stress and can lead to decreased cardiovascular mortality and morbidity,” says Sonal Tanwar, PhD, a scholar in preventative cardiology, and Naresh Sen, DM, PhD, a consultant cardiologist, both at HG SMS Hospital, Jaipur, India. “Heart disease patients could benefit from learning Indian yoga and making it a routine part of daily life.”
Yoga, Meditation Improve Brain Function And Energy Level
In another recent study from the University of Waterloo, practicing brief sessions of Hatha yoga and mindfulness meditation can significantly improve brain function and energy levels. The study found that practicing just 25 minutes of Hatha yoga or mindfulness meditation per day can boost the brain’s executive functions, cognitive abilities linked to goal-directed behavior, and the ability to control knee-jerk emotional responses, habitual thinking patterns and actions.
“Hatha yoga and mindfulness meditation both focus the brain’s conscious processing power on a limited number of targets like breathing and posing, and also reduce processing of nonessential information,” says Peter Hall, associate professor in the School of Public Health & Health Systems. “These two functions might have some positive carryover effect in the near- term following the session, such that people are able to focus more easily on what they choose to attend to in everyday life.”
Hatha yoga is one of the most common styles of yoga practiced in Western countries. It involves physical postures and breathing exercises combined with meditation. Mindfulness mediation involves observing thoughts, emotions and body sensations with openness and acceptance.
“Although the meditative aspect might be even more important than the physical posing for improving executive functions, there are additional benefits to Hatha yoga including improvements in flexibility and strength,” said Hall. “These benefits may make Hatha yoga superior to meditation alone, in terms of overall health benefits.”
Thirty-one study participants completed 25 minutes of Hatha yoga, 25 minutes of mindfulness meditation, and 25 minutes of quiet reading – a control task – in randomized order. Following both the yoga and meditation activities, participants performed significantly better on executive function tasks compared to the reading task. “This finding suggests that there may be something special about meditation – as opposed to the physical posing – that carries a lot of the cognitive benefits of yoga,” added Kimberley Luu, lead author on the paper.
The study also found that mindfulness meditation and Hatha yoga were both effective for improving energy levels, but Hatha yoga had significantly more powerful effects than meditation alone. “There are a number of theories about why physical exercises like yoga improve energy levels and cognitive test performance,” Luu said. “These include the release of endorphins, increased blood flow to the brain, and reduced focus on ruminative thoughts. Though ultimately, it is still an open question.”
Combining Yoga And Medical Studies To Connect, Recharge, Remember
Yoganatomy is a class at the Perelman School of Medicine that combines traditional yoga practice with reinforcement of lessons in gross anatomy. By mindfully moving and breathing with the body parts that earlier in the day they had learned about in lectures and examined up-close in donated cadavers in the lab, first-year medical students at Penn gain a deeper appreciation of these structures in a living body.
“The primary goal of Yoganatomy is to give the students an outlet to help them with their stress,” said Nikki Robinson, the yoga instructor who developed and leads these classes, which began last fall. “The demands on medical students’ time are so intense that this class offers students a way to unwind and exercise easily on the medical school campus when they otherwise might not find the time to seek that out. Here’s an hour when they’re going to move, breathe, talk about things we learned in the anatomy lab, and then rest, so they’re recharged to go about the rest of their day.”
Going All In For The Med Students
Robinson made the unusual educational twist from yoga teaching into the medical school classroom through a connection with Mitchell Lewis, DPhil, a professor of Biochemistry and Biophysics. Lewis teaches the first-year medical students intermediary metabolism with a level of dedication to education that is hard to understate. Though Lewis is a basic scientist whose professional life is in a lab, a number of years ago he took a sabbatical and audited the first-year medical school curriculum at Penn in order to get a better understanding of how his class fits into the broader preclinical curriculum. “Of all the preclinical courses, I found anatomy the most fascinating,” he said. “I visit and spend several hours in the gross labs with every new class.”
A few years ago, Lewis started attending yoga classes at the Yoga Garden, where Robinson leads classes that have a strong anatomical bent. The idea soon came to life when Lewis approached Neal Rubenstein, MD, PhD, the gross anatomy course director, about the possibility of integrating yoga with gross anatomy. Together, the three devised a plan to augment traditional medical education with anatomically-based yoga. Rubenstein even suggested that Robinson attend and learn firsthand what medical students experienced in the gross labs.
“I love this, and it is really important for me to be able to accurately reflect and represent what the students are taught,” Robinson said. “If they’re going to be in my care, I want to reinforce what they’re learning on the table, and then take that and interpret it in an accurate way, to physically put it in their body.”
This summer, Robinson completed a gross anatomy course at Rowan University, taught in part by James White, PhD, one of Penn Med’s most esteemed teachers. This fall, Robinson will assist the first-year students in gross lab and continue teaching Yoganatomy to the new crop of students.
Yoganatomy runs in many ways as a typical yoga class, except for the parts that sound more like a gross anatomy study session. When students are in plank pose — which is essentially holding the “up” position of a push-up — Robinson might say, “Now retract the scapula.” Students are forced to think about the muscles connected to the scapula and to recall the distinction between protraction and retraction. “I try to straddle keeping it really serious and medically accurate and just giving them something fun to do,” Robinson said.
After gross anatomy and the end of the first semester, medical education with a yogic corollary isn’t over for Penn medical students. The leader of the next yoga class in the sequence is an inversion of Robinson: instead of a yoga instructor-turned-part-time-med-school-attendee, Sila Bal is a full-time medical student who became certified as a yoga instructor. Now a fifth-year MD/MPH student at Penn, Bal incorporates her knowledge of anatomy and physiology into teaching yoga classes.
But soon after she began teaching, she got to thinking, “Wouldn’t it have been cool if when I was an MS1 or MS2, someone had gone through what is or isn’t physiologically plausible that’s taught in yoga classes?” She also thought back on the experience she had working as a research assistant on a study of yoga breathing as a tool to help patients with depression.
When the paper resulting from that study was published, Bal decided to connect it with the brain and behavior curriculum taught as part of Mod 2, a preclinical learning block focused on organ systems and disease that spans from January of medical students’ first year through December of their second year. Over the course of the last spring semester, Bal developed and taught multiple classes connected to the topics in Mod 2 and called them Medically-Informed Yoga.
Evidence Through The Ages
“I pick a paper from a reputable journal with trustworthy results and use that as a starting point for our discussions,” Bal said. In the brain and behavior module, “we went through depression and the physiology behind depression, the results of the paper, and physiological bases of the use of yoga in depression. Depression has a lot of research behind it. For example, we know yoga stimulates the parasympathetic nervous system.”
After a brief discussion, Bal leads the students through a 45-minute sequence of the asanas, or physical postures that yoga teachers recommend for the organ system under discussion, to practice what they learned. Bal points out that in some organ systems, the connection with these asanas has not necessarily been demonstrated through medical research, but often yogic knowledge, honed through thousands of years of practice and experience, reflects a different type of “evidence through the ages.”
The two yoga class sequences – Yoganatomy for first-semester medical students in gross anatomy, and Medically-Informed Yoga for second, and third-semester medical students in Mod 2 — arose independently by luck or chance last year. This year, the two programs are coming into alignment. Bal and Robinson are working together to develop a coordinated curriculum of yoga classes to complement the full span of the three semesters of preclinical medical education that can be standardized and repeated in future years.
Already this year, yoga as a study enhancement is front and center for new students. During their orientation to medical school, new first-year students received an introduction to Yoganatomy and Medically-Informed Yoga, and participated in a brief demo. Bal, Lewis, and Robinson believe that all medical students can benefit from yoga through integrating stress relief, exercise, and connection into their often high-stress learning experience. “I encouraged all of the students in my biochemistry class to participate in Yoganatomy,” Lewis said. “This past year our Yoganatomy attracted many medical students that have never been exposed to yoga.”
“Attendance was highest last fall at the sessions when Lewis participated,” Robinson said. “The students wanted to see their professor’s moves, including an impressive handstand.” The sessions also lured more senior medical students — some of whom said that Robinson’s Yoganatomy quizzes helped them study for board exams. Yoganatomy also attracted faculty and graduate students from other schools at Penn.“This year we hope to encourage more medical faculty to participate in Yoganatomy,” Lewis said. “We are open to any and everyone who wants to join,” Bal added.
Yoga More Risky For Causing Musculoskeletal Pain Than You Might Think
Yoga causes musculoskeletal pain in 10 percent of people and exacerbates 21 percent of existing injuries, University of Sydney research shows. Published recently in the Journal of Bodywork and Movement Therapies, the findings come from the first prospective study to investigate injuries caused from recreational participation in yoga. Yoga is an increasingly popular complementary or alternative therapy for musculoskeletal disorders, with millions of people practicing worldwide.
“While yoga can be beneficial for musculoskeletal pain, like any form of exercise, it can also result in musculoskeletal pain,” said lead researcher Associate Professor Evangelos Pappas from the University’s Faculty of Health Sciences, who conducted the study with Professor Marc Campo from Mercy College, New York.
“Our study found that the incidence of pain caused by yoga is more than 10 percent per year, which is comparable to the injury rate of all sports injuries combined among the physically active population. However, people consider it to be a very safe activity. This injury rate is up to 10 times higher than has previously been reported.
“We also found that yoga can exacerbate existing pain, with 21 percent of existing injuries made worse by doing yoga, particularly pre-existing musculoskeletal pain in the upper limbs,” Pappas added. “In terms of severity, more than one-third of cases of pain caused by yoga were serious enough to prevent yoga participation and lasted more than three months.”
The study found that most ‘new’ yoga pain was in the upper extremities – shoulder, elbow, wrist, hand – possibly due to downward dog and similar postures that put weight on the upper limbs. It’s not all bad news, however, as 74 percent of participants in the study reported that existing pain was improved by yoga, highlighting the complex relationship between musculoskeletal pain and yoga practice.
“These findings can be useful for clinicians and individuals to compare the risks of yoga to other exercise enabling them to make informed decisions about which types of activity are best. Pain caused by yoga might be prevented by careful performance and participants telling their yoga teachers of injuries they may have prior to participation, as well as informing their healthcare professionals about their yoga practice.
“We recommend that yoga teachers also discuss with their students the risks for injury if not practiced conscientiously, and the potential for yoga to exacerbate some injuries,” Pappas added. “Yoga participants are encouraged to discuss the risks of injury and any pre-existing pain, especially in the upper limbs, with yoga teachers and physiotherapists to explore posture modifications that may results in safer practice.”
Another study published in a recent issue of the Journal of Clinical Sleep Medicine indicates that yoga and aerobic exercise interventions did not significantly reduce objectively measured sleep disturbances among midlife women who were experiencing hot flashes.
Secondary analyses of a randomized controlled trial showed that neither 12 weeks of yoga nor 12 weeks of aerobic exercise had a statistically significant effect on objective measures of sleep duration or sleep quality recorded by actigraphy. Although the women had no difficulty falling asleep, disturbed sleep was common at baseline and remained after each intervention, with women in all groups waking during the night for an average of more than 50 minutes.
According to the authors, previously published analyses of the same trial had found that the yoga and aerobic exercise interventions were associated with small but statistically significant improvements in subjective, self-reported sleep quality and insomnia severity. The primary findings were that the two study interventions had no significant effects on objective sleep outcomes in midlife women with hot flashes.
Examining Other Treatments
The main implication of this finding is that other behavior treatments with the potential for effectively improving sleep in this population should be examined,” says lead author Diana Taibi Buchanan, associate professor of Bio-Behavioral Nursing and Health Informatics at the University of Washington in Seattle.
The authors analyzed data from the Menopause Strategies: Finding Lasting Answers for Symptoms and Health (MsFLASH) network. The study involved 186 late transition and postmenopausal women with hot flashes who were between 40 and 62 years of age. Study subjects had an average of 7.3 to 8 hot flashes per day. Participants were randomized to 12 weeks of yoga, supervised aerobic exercise, or usual activity.
Sleep measures were evaluated using wrist actigraphy, and bedtimes and rise times were determined primarily from the participants’ sleep diaries. Mean sleep duration at baseline and after each intervention was less than the seven or more hours of nightly sleep that is recommended by the American Academy of Sleep Medicine for optimal health in adults.
Future research should explore other approaches for improving sleep quality in midlife women, such as cognitive behavioral therapy for insomnia.