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Yoga Page Four


Written by: Manoj Dash
THE CONCEPT OF HEALTH IN ANCIENT YOGA TEXTS. The ancient Indian science, Yoga, has its origin in the Sankhya philosophy of Indian culture, which is about 8000 years old (Nagarathna, 2001). Yoga includes a wide range of techniques (e.g., physical postures, regulated breathing, cleansing techniques, meditation, philosophical principles, and devotional sessions, surrendering to the Supreme). These techniques bring about a calm and balanced state of mind, and are expected to help the spiritual evolution of the individual. However, yoga has more pragmatic applications in medicine. In order to understand these, it is important to know the concepts of ‘health’ and ‘disease’ in Yoga texts. According to yoga, man is in perfect health and homeostasis at his subtle levels of existence. All diseases are classified as (i) stress-related (adhija) and (ii) not stress related, e.g., injuries (anadhija). Yoga has been considered especially useful in the management of stress related disorders. This review will describe (i) therapeutic applications of yoga, under four categories, detailed below (ii) yoga in the prevention of disease and (iii) yoga for the promotion of positive health. THERAPEUTIC APPLICATIONS OF YOGA. Yoga has been used in the management of a wide range of diverse ailments. Four categories of conditions will be described below, with a few examples in each case. These four categories are (i) disorders with a known lifestyle-related or psychosomatic link (ii) life threatening and degenerative disorders (iii) occupation-related disorders and (iv) disorders related to development and aging. (i) Disorders with a known lifestyle-related or psychosomatic link: The conditions which will be covered under this category are bronchial asthma, non-insulin dependent diabetes mellitus, essential hypertension, coronary heart disease, and rheumatoid arthritis. Of all these conditions the therapeutic benefit of yoga in bronchial asthma has been studied in the most detail. The earliest study reported that Transcendental Meditation was a useful adjunct in treating bronchial asthma (Wilson, Honsberger, Chiu, & Novey, 1975). Subsequently, a controlled trial on fifty-three patients in a yoga group compared with an equal number in a control group, showed greater improvement in scores for drug treatment, peak flow rate, and decreased weekly attacks of asthma, following two weeks of yoga (Nagarathna & Nagendra, 1985). The yoga practice was an ‘integrated approach’ with techniques which were intended to influence physical, mental, and emotional functioning. A similar approach was used in another study with 570 patients followed up over 54 months (Nagendra & Nagarathna, 1986). The patients who practiced yoga regularly (i.e., at least 16 days in a month), showed maximum improvement, followed by those practiced regularly to begin with and later discontinued, while irregular practitioners showed the least benefits. The idea of studying the effect of a single yoga technique was the basis of the study by Singh (1987). Here, patients practiced a yoga cleansing technique (kunjal), and found definite subjective and objective improvement in the week they performed the practice, as well as improved symptoms for three weeks after. A much more rigorous study was conducted using the “randomized, double-blind, crossover trial” design (Singh, Visniewski, Britton, & Tattersfield, 1990). There was a significant increase in the dose of histamine needed to provoke a 20% reduction in FEV1 (PD20), during yoga breathing, but not with the control. Exercise tolerance in children with asthma who practiced yoga was studied with a two year follow up (Jain, Rai, Valecha, Jha, Bhatnagar, & Ram, 1991). They showed an increase in pulmonary functions and exercise capacity, with reduced symptom scores and drug requirements. In contrast, another study compared the effects of yoga with those of breathing exercises over a 3 week period. The breathing exercises significantly improved lung functions whereas yoga did not (Fluge, Richter, Fabel, Zysno, Weller, & Wagner, 1994). More recently, an attempt was made to understand whether correction in autonomic imbalances in asthmatics explained the benefits of yoga (Khanam, Sachdeva, Guleria, & Deepak, 1996). The results indicated that yoga may be beneficial by reducing sympathetic reactivity and improving pulmonary ventilation by relaxing voluntary inspiratory and expiratory muscles. Another area of interest was to determine whether yoga would be beneficial to asthmatics belonging to another race. The study was performed on University students with asthma in North America (Vedanthan, Kesavalu, Murthy, Duvall, Hall, Baker, & Nagarathna, 1998). The yoga group reported a significant degree of relaxation, positive attitude, better exercise tolerance and lesser usage of beta adrenergic inhalers. A further attempt was made to understand whether yoga reduces the basic problem in asthma (i.e., airway hyperresponses by studying the effect of Sahaja yoga on subjective measures as well as airway hyperresponsiveness to methacholine. The yoga group showed an improvement in airway hyperresponsiveness as compared to the control group (Manocha, Marks, Kechington, Peters, & Salome, 2002). A more recent study (Jaber, 2002), reviewed a wide range of alternate and complementary therapies for bronchial asthma. It was concluded that for the motivated patient mind-body interventions such as yoga, hypnosis, biofeedback assisted relaxation and breathing exercises are beneficial for stress reduction in general and may be useful in controlling asthma. In another review article (Steurere-Stey, Russi, & Steurer, 2002) it was concluded that evidence is lacking that alternative forms of medicine are more effective than a placebo in asthma. However, it was also mentioned that lack of evidence does not always mean that treatment is ineffective but it could mean that effectiveness has not been adequately investigated. The effect of 40 days of yoga therapy was studied on blood glucose and glucose tolerance by the oral glucose tolerance test in 149 non insulin dependent diabetics. There was a significant reduction in hyperglycemia, area index total under the OGTT curve and decrease in oral hypogycaemic drugs required for normogycemia following yoga (Jain, Uppal, Bhatnagar, & Talukdar, 1993). Similarly a beneficial effect of yoga was seen in a more recent study on the effects of yoga in the prevention of Type II diabetes (Sahay & Sahay, 2002). Another disorder which significantly benefited by yoga therapy was rheumatoid arthritis. A study conducted in England demonstrated that hand grip strength significantly improved following yoga in rheumatoid arthritis patients (Haslock, Monro, Nagarathna, Nagendra, & Raghuram, 1994). It was subsequently proven that yoga resulted in similar benefits in rheumatoid arthritis patients in an Indian population (Dash & Telles, 2001). It is increasingly being understood that yoga has potential benefit for patients with coronary artery disease. In an one-year prospective randomized controlled trial, yoga practice was shown to significantly reduce the number of anginal episodes per week, improve exercise capacity, decrease body weight and serum cholesterol (Manchanda, Narang, Reddy, Sachdeva, Prabhakaran, Dharmanand, Rajani, & Bijlani, 2000). These results are in line with those of the well known study of Dean Ornish (“Reversing Heart Disease, 1996”). Closely related to coronary arterial disease is the effect of yoga on essential hypertension. The most rigorous and early trials were conducted by (Patel, 1977). More recently it was shown that yoga decreases the blood pressure and risk factors (blood glucose, cholesterol and triglycerides), and improves subjective well being and quality of life in mild to moderate hypertensives (Damodaran, Malathi, Patil, Shah, Suryavanshi, & Marathe, 2002). There was also a decrease in VMA ( a nor-adrenalin metabolite) suggesting decrease in sympathetic activity. Hence yoga appears to reduce risk factors for cardiovascular disease in mild to moderate hypertension. (ii) Life threatening and degenerative disorders: Approximately 40% of the population in North America (where the statistics are available) use complementary and alternative medicine for chronic disorders. Individual case studies of two patients with Sarcoidosis and with Parkinson’s disease who received a traditional comprehensive system of natural medicine showed benefits during the three week residential treatment, in terms of reduced symptoms, signs and need for conventional medication (Nader, Rothenberg, Averbach, Charles, Fields, & Schneider, 2000). Another chronic disorder which is being increasingly managed with complementary treatments is multiple sclerosis. A survey conducted in Germany showed that 63.6% of 129 patients were using alternative therapies (Winterholler, Erbguth, & Nundorfer, 1997). This survey showed that most patients used homeopathy, herbs, yoga and various diets. Most patients thought that there was some benefit from these treatments. Alternative treatments have also been used for another chronic and baffling condition, viz. fibromyalgia. This chronic illness is characterized by pain, fatigue, sleep disturbance and resistance to treatment (Kaplan, Goldenberg, & Galvin-Nadeau, 1993). Ten weeks of a meditation-based intervention brought about an improvement in 51% (of 77 patients), based on various condition-specific questionnaires. More difficult to manage is patients found to be HIV positive, as there are both immunological and psychological factors involved. A study evaluated the effects of a behavioral stress-management program on anxiety, mood, self-esteem, and T-cell counts in HIV-positive men, who were asymptomatic, except for T cell counts below 400 (Taylor, 1995). Following 20 weeks of sessions of progressive muscle relaxation, meditation, and hypnosis, the treatment group showed a significant improvement in anxiety, mood, self-esteem, and T-cell counts. With the increasing knowledge of psycho-neuro-immunological interactions, there has been an increasing interest in using stress management in cancer. For example, it was shown that an increasing number of women with breast cancer were seeking alternative treatments in addition to the conventional management (Targ & Levine, 2002). Another study examined the relationships between a mindfulness based stress reduction meditation and quality of life, mood states, stress symptoms and cytokine production (Carlson, Speca, Patel & Goodey, 2003). All the psychological measures improved and this study was the first to show changes in cancer-related cytokine production associated with practicing meditation. For the first time, a randomized, controlled trial investigated the effects of yoga for a chronic infectious disorder, i.e., pulmonary tuberculosis (Naveen & Telles, 2003). It was found that a yoga group improved with respect to bacteriological status (sputum microscopy, culture), radiography, FVC, weight gain and symptoms, suggesting that yoga potentiates the action of chemotherapy in converting an active infection to a passive one. There are certain psychiatric disorders which remain unresponsive to treatment in spite of the advances in pharmacological management. As obsessive compulsive disorder is often difficult to treat, an attempt was made to add yoga to the conventional management in eight patients (Shannahoff-Khalsa & Beckett, 1996). There were some improvements in terms of symptoms and required medication though the authors concluded that further research was needed. (iii) Occupation related disorders: With the widespread use of computers these days there is an increasing awareness that prolonged computer use can lead to health hazards such as musculoskeletal problems (i.e., repetitive stress injuries, including carpal tunnel syndrome), visual strain, and mental stress. A randomized controlled trial evaluated the use of yoga postures as compared to the conventional management (splints) in patients with carpal tunnel syndrome (Garfinkel, Singhal, Katz, Allan, Reshtar, & Schumacher, 1998). Yoga was found to be more effective than splints in reducing symptoms and signs of carpal tunnel syndrome. A review article evaluated various non-surgical treatments for carpal tunnel syndrome (O’Connor, Marshall, & Massy-Westropp, 2003). This review showed that there were significant short-term benefits from oral steroids, splinting, ultrasound, yoga and carpal bone mobilization. Another occupation related stress is working alternately in day and in night shifts, as this has been recognized to upset the diurnial rhythm. The Indian Council of Medical Research (New Delhi) found yoga beneficial for the psychological and physical health of nurses (Walia, Mehra, Grover, Earnest, Verma, & Sanjeev, 1989). It must be remembered that these are just two examples of how yoga can reduce stresses imposed by the work situation. (iv) Disorders related to development and aging: Yoga has been used with benefit in people of different age groups with different needs. Two examples (of children and of older persons) will be given here. A study on 250 school boys showed that they were less flexible than would be expected for their age (Gharote, 2000). It was suggested that practising yoga postures would reduce this functional deficit. It is now recognized that with aging certain changes are likely to occur in memory, hearing, vision, gait, balance, and in exercise capacity. Gerontology has accepted that alternative medicine strategies may be useful for all these functions, as well as to improve the psychological status of the older people involved. A ten-week yoga program was implemented with elders at community sites, with physical and psychological benefits, though the benefits appeared to depend on race (white versus black) and socio-economic status (Haber, 1983). A recent review article looked at alternative methods of managing problems associated with aging (Schneider, Alexander, Salerno, Robinson, Fields, & Nidich, 2002). The authors concluded that these innovative strategies may help society achieve recommended health objectives for older adults, and that widespread implementation of this self-empowering, prevention-oriented approach in the elderly is feasible, cost-effective, and timely. YOGA FOR DISEASE PREVENTION. As described in the paragraph above, yoga has an important role to play in the prevention of disease. While this is especially important in the elderly (Go, Champaneria, 2002), it is also important in all vulnerable people. This includes highly stressed persons whose immune function may be compromised, or those whose lifestyle (i.e., diet, exercise, relaxation) is ‘unhealthy’. A few examples of yoga for disease prevention will be given here. Within this past century we have doubled the life-span of human beings. Genomic medicine, including stem cell research, cloning, and gene therapy can be expected to treat more diseases. However we can expect more chronic diseases related to aging, environment, and lifestyle, such as cancer, diabetes, osteoporosis, connective tissue disorders, cardiovascular disease, and migraine (Reilly, 1994). Hence the new, alternative strategies can fuse the antiquity of ancient healing with the innovations of modern medicine to increase life expectancy and improve the quality of life, the world over. YOGA FOR THE PROMOTION OF POSITIVE HEALTH. Finally, it has to be emphasized that while yoga has important therapeutic benefits, the practice of yoga is very important in the promotion of positive health and human potential in body, mind, and spirit (Scott, 1999). References: 1. Nagarathna R. Yoga in medicine. API Text book of medicine (6th ed), 2001. 2. Wilson AF, Honsberger R, Chiu JT, & Novey HS. Transcendental meditation and asthma. Respiration. 1975 32(1): 74-80. 3. Nagarathna R, & Nagendra HR. Yoga for bronchial asthma: a controlled study. Br Med J. 1985 291 (6502): 1077-9. 4. Nagendra HR, & Nagarathna R. An integrated approach of yoga therapy for bronchial asthma: a 3-54- month prospective study. J Asthma. 1986 23(3): 123-37. 5. Singh V. Kunjal: a nonspecific factor in management of bronchial asthma. J Asthma. 1987 24(3): 183-6. 6. Singh V, Wisniewski A, Britton J, & Tattersfield A. Effect of yoga breathing exercises (pranayama) on airway reactivity in subjects with asthma. Lancet. 1990 335(8702): 1381-3. 7. Jain SC, Rai L, Valecha A, Jha UK, Bhatnagar SO, & Ram K. Effect of yoga training on exercise tolerance in adolescents with childhood asthma. J Asthma. 1991 28(6): 437-42. 8. Fluge T, Richter J, Fabel H, Zysno E, Weller E, & Wagner TO. Long term effects of breathing exercises and yoga in patients with bronchial asthma. Pneumologie. 1994 48(7): 484-90. 9. Khanam AA, Sachdeva U, Guleria R, & Deepak KK. Study of pulmonary and autonomic functions of asthma patients after yoga training. Indian J Physiol Pharmacol. 1996 40(4): 318-24. 10. Vedanthan PK, Kesavalu LN, Murthy KC, Duvall K, Hall MJ, Baker S, & Nagarathna S. Clinical study of yoga techniques in university students with asthma: a controlled study. Allergy Asthma Proc. 1998 19(1): 3-9. 11. Manocha R, Marks GB, Kenchington P, Peters D, & Salome CM. Sahaja yoga in the management of moderate to severe asthma: a randomized controlled trial. Thorax. 2002 57(2): 110-5. 12. Jaber R. Respiratory and allergic diseases: from upper respiratory tract infections to asthma. Prim care. 2002 29(2): 231-61. 13. Steurer-Stey C, Russi EW, & Steurer J. Complementary and alternative medicine in asthma: do they work? Swiss Med Wkly. 2002 132(25-26): 338-44. 14. Jain SC, Uppal A, Bhatnagar SO, & Talukdar B. A study of response pattern of non-insulin dependent diabetics to yoga therapy. Diabetes Res Clin Pract. 1993 19(1): 69-74. 15. Sahay BK, & Sahay RK. Lifestyle modification in management of diabetes mellitus. J Indian Med Assoc. 2002 100(3): 178-80. 16. Haslock I, Monro R, Nagarathna R, Nagendra HR, & Raghuram NV. Measuring the effects of yoga in rheumatoid arthritis. Br J Rheumatol. 1994 33(8): 787-8. 17. Dash M, & Telles S. Improvement in hand grip strength in normal volunteers and rheumatoid arthritis patients following yoga training. Indian J Physiol Pharmacol. 2001 45(3): 355-60. 18. Manchanda SC, Narang R, Reddy KS, Sachdeva U, Prabhakaran D, Dharmanand S, Rajani M, & Bijlani R. Retardation of coronary atherosclerosis with yoga lifestyle intervention. J Assoc Physicians India. 2000 48(7): 687-94. 19. Patel CH. Biofeedback aided relaxation and meditation in the management of hypertension. Biofeedback Self Regul. 1977 291): 1-41. 20. Damodaran A, Malathi A, Patil N, Shah N, Suryavanshi, & Marathe S. Therapeutic potential of yoga practices in modifying cardiovascular risk profile in middle aged men and women. J Assoc Physicians India. 2002 50(5): 633-40. 21. Nader T, Rothenberg S, Averbach R, Charles B, Fields JZ, & Schneider RH. Improvements in chronic diseases with a comprehensive natural medicine approach: a review and case series. Behav Med. 2000 26(1): 34-46. 22. Winterholler M, Erbguth F, Neundorfer B. The use of alternative medicine by multiple sclerosis patients –patient characteristics and patterns of use. Fortschr Neurol Psychiatr. 1997 65(12): 555-61. 23. Kaplan KH, Goldenberg DL, & Galvin-Nadeau M. The impact of a meditation-based stress reduction program on fibromyalgia. Gen Hosp Psychiatry. 1993 15(5): 284-9. 24. Taylor DN. Effects of a behavioral stress-management program on anxiety, mood, self esteem. and T-cell count in HIV positive men. Psychol Rep. 1995 76(2): 451-7. 25. Targ EF, & Levine EG. The efficacy of a mind-body-spirit group for women with breast cancer: a randomized controlled trial. Gen Hosp Psychiatry. 2002 24(4): 238-48. 26. Carlson LE, Speca M, Patel KD, & Goodey E. Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress, and immune parameters in breast and prostate cancer outpatients. Psychosom Med. 2003 65(4): 571-81. 27. Naveen KV, & Telles S. Randomized trial of yoga as a complementary therapy for pulmonary tuberculosis. Respirology. 2003 (In press). 28. Shannahoff-Khalsa DS, & Beckett LR. Clinical case report: efficacy of yogic techniques in the treatment of obsessive compulsive disorders. Int J Neurosci. 1996 85(1-2): 1-17. 29. Garfinkel MS, Singhal A, Katz WA, Allan DA, Reshetar R, & Schumacher HR Jr. Yoga – based intervention for carpel tunnel syndrome: a randomized trial. JAMA. 1998 280(18): 1601-3. 30. O’Connor D, Marshall S, & Massy-Westropp N. Non-surgical treatment (other than steroid injection) for carpel tunnel syndrome. Cochrane Database Syst Rev. 2003 (1): CD003219. 31. Walia IJ, Mehra P, Grover P, Earnest C, Verma SK, & Sanjeev. Health status of nurses and yoga. I. Baseline data. Nurs J India. 1989 80(9): 235-7. 32. Gharote MM. Minimum muscular fitness in school children. Indian J Physiol Pharmacol. 2000 44(4): 479-84. 33. Haber D. Yoga as a preventive health care program for white and black elders: an exploratory study. Int J Aging Hum Dev. 1983 17(3): 169-76. 34. Schneider RH, Alexander CN, Salerno JW, Robinson DK Jr, Fields JZ, & Nidich SI. Disease prevention and health promotion in the aging with a traditional system of natural medicine: Maharishi Vedic Medicine. J Aging Health. 2002 1491): 57-78. 35. Go VL, & Champaneria MC. The new world of medicine: prospecting for health. Nippon Naika Gakkai Zasshi. 2002 91 suppl: 159-63. 36. Reilly R. Acute and prophylactic treatment of migraine. Nurs Times. 1994 90(29): 35-6. 37. Scott AH. Wellness works: community service health promotion groups led by occupational therapy students. Am J Occup Ther. 1999 53(6): 566-74.

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