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Yoga Page Four
THERAPEUTIC APPLICATIONS OF YOGA: A REVIEW |
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Written by: Manoj Dash
http://www.geocities.com/manojrieneke/Research.html |
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| 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),
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SO, & Ram K. Effect of yoga training on exercise tolerance in adolescents with childhood asthma. J Asthma. 1991 28(6):
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