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8/7/2019 Yoga for Clerkship
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Yoga and Medicine
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3 Questions
� What is Yoga?
� What is the evidence that Yoga has
health benefits?� How do I use and prescribe Yoga as
a physician?
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Yoga
� 5000 years old
� founded in India
� The word ³Yoga´
means ³yoke´ or ³unity´ translatedfrom Sanskrit, theclassical language of India.
� It also means ³discipline´ or ³effort.´
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Yoga
� Yoga requires youto make an effortto unify your body
and mind.� You do this by
concentrating yourawareness on yourphysical bodythrough breathingand postures.
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Meditation is part of Yoga
� Meditation is a technique in whichthe meditator seeks not only to
reach a deep state of relaxation, butto quiet the mind.
� The mind is a chattering monkeythat one tries to make quiet withmeditation.
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Meditation seeks a state of
enlightenment, a freedom from thetyranny of our worries.
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Types of Yoga
The approach to Yoga that f ocuses on postur es is called Hatha (haht-hah) Yoga.
� Ananda
� Ashthanga� Bikram
� Iyengar
� Kundalini
� Sivananda
� Viniyoga
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Yoga breathing
� Abdominal breathing
� Sends a fax to the brain to relax
� Close your eyes
� Put your hand on your belly
� Imagine «..
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Yoga postures (Asanas)
� Asanas are the heart of Hatha Yoga
� Stretching that maintains and enhancesflexibility
� Many poses are a form of isometricstrengthening exercise, which involve thecontraction of muscles without moving the
joint.� Isometric exercise is often used in
physical therapy for the rehabilitation of injured joints.
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Meditation techniques
� Focused
� Mantra
� Walking
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Focused Meditation
� is a technique in which you direct yourawareness onto something.
± a picture or statue of a deity
± a universal principle such as compassion orforgiveness
± or the syllable OM, the famous Hindumantra.
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Mantra meditation
� In Sanskrit, the ³man´ in mantrameans ³to think,´ and ³tra´ suggestsinstrumentality.
� Mantra literally means an instrumentof thought.
� You repeat a word, phrase or soundin order to transcend the constantdistractions of the mind.
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Transcendental Meditation
(TM)
� movement foundedby Maharshi
Mahesh Yogi of India.
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Functional Mapping of
Meditation
� Meditation is a conscious mental processthat induces a set of integrated
physiologic changes termed the ³relaxation response´ by Herbert Benson.
� Functional magnetic resonance imaging(fMRI) was used to identify andcharacterize the brain regions that areactive during a simple form of meditation.
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Results
� Significant signal increases were observed in thedorsolateral prefrontal and parietal cortices,hippocampus/parahippocampus, temporal lobe,pregenual anterior cingulate cortex, striatum, and
pre- and post-central gyri during meditation.
� This indicates that the practice of meditationactivates neural structures involved in attentionand control of the autonomic nervous system.
± Neuroreport. 2000 May 15;11(7):1581-5. Functionalbrain mapping of the relaxation response andmeditation. Lazar SW,«, Benson H.
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Decr ease in Beta-wave activity after meditation
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Question
� What is the evidence that
Yoga/meditation have healthbenefits?
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There is good scientificevidence that exercise:
� Increases muscle and bone strength
� Increases lean muscle and decreases
body fat� Helps control weight
� Enhances your psychological well-
being, reduces depression� Reduces symptoms of anxiety and
improves your general mood
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Yoga is exercise
� Stretching forflexibility
� Improved Strength
� Improved Balance
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Evidence for Health Benefits of Yoga
� HTN ± Relaxation Response
� Carpal Tunnel Syndrome
� Asthma and improved vital capacity� Stress reduction to diminish the
many conditions caused or made
worse by stress.
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Relaxation Response
� Herbert Benson,MD
� founding President
of the Mind/BodyMedical Institute
� Associate Professorof Medicine,Harvard MedicalSchool
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Relaxation Response
� Sit comfortably with your eyes closed.
� Pay attention to your breathing, and
repeat a word or phrase or prayer silently to yourself as you exhale.
� When you notice your mind wandering
(It will) just notice it and passively bring
your attention back to your breathing.
± A f or m of meditation.
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Autonomic NS
� Sympathetic NS
� Parasympathetic
NS
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ight or Flight
� Whether you fight or run, your sympathetic nervous system will be on over dr ive
pumping out nor -epinephr ine.� What ar e the physiological
effects of this process?
� Why would you not want this to be a chronic state of
existence?
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Fight or Flight
� Yoga and meditation decrease thissympathetic tone and reduce feelingsof stress and anxiety
� Many modern health problems areworsened by stress and anxiety
� Yoga works to decrease sympathetictone
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Relaxation Response
� Significantly greater reductions inpsychological distress, anxiety, andperceived stress were found in the
experimental group who had learned therelaxation response.
± The evaluation of a mind/body intervention toreduce psychological distress and perceived
stress in college students. ± Deckro GR, «, Benson H.
± J Am Coll Health. 2002 May;50(6):281-7.
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Yoga can prevent Seizures
� More than 50% reduction in seizurefrequency and duration comparedwith the control groups.
±Cochrane Database Systematic Rev.2000;(3)
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Yoga for PoststrokeRehabilitation
� A yoga-based exercise program forpeople with chronic poststrokehemiparesis.
±Pilot study with four patients
� Gentle exercise program adapted forpeople who have had a stroke.
� Yoga showed some benefit.
±Bastille JV, Gill-Body KM. Phys Ther.
2004 Jan;84(1):33-48.
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Pain in the hands
� Evaluation of a yoga based regimenfor treatment of osteoarthritis of thehands.
� The Yoga program was effective inproviding relief in hand
osteoarthritis.
Garfinkel MS, et al. J Rheumatol. 1994Dec;21(12):2341-3.
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Carpal Tunnel Syndrome
� ³Current evidence shows significant short-term benefit from oral steroids, splinting,ultrasound and yoga.´
� Cochrane review, Issue 1, 2004.
� Garfinkel, et al. Yoga-Based Interventionfor Carpal Tunnel Syndrome. ARandomized Trial. JAMA. 1998
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Health Conditions in which
Yoga may help heal or treat� Arthritis� Allergies� Asthma� Hypertension
� Coronary ArteryDisease
� Irritable BowelSyndrome
� Heartburn (GERD)
� Constipation� Tension Headaches
and Migraines
� PMS and MenstrualDiscomfort
� Menopause
� Pain of the Back, Hips,Knees
� Depression & Anxiety
� Substance Abuse
� Skin Disorders
� Chronic FatigueSyndrome
� Overweight
� Sleep Problems
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Yoga and Meditation to stay
healthy
� Exercise and relaxation can reduce
feelings of stress and keep the bodyand mind healthy
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Question
� How do I use and prescribe Yoga as
a physician?
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Treating Back Pain with
Yoga
� Similarities to PT
±Williams flexion exercises±McKenzie extension exercises
� Addition of breathing and relaxation
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Yoga and Meditation
� As forms of medical treatments doYoga and Meditation meet standards
for being safe and effective?
� Safer than most medications
±No adverse effects such as allergicreactions, liver or kidney damage asseen with some medications.
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Safety
� Safe from musculoskeletal injuries if you listen to your own body
� No pain and a lot of gain� Avoid postures that you can¶t handle
� Can continue in to older age ± 80year old yoga teacher in San Antonio
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Effective
� We have reviewed some studies showingeffectiveness for certain conditions
� More studies are being done� People only continue Yoga when they find
that it works for them� Built in effectiveness meter� People often continue medications when
they see or feel no benefit and are subject
to real side effects
� Can be free ± cost effective
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Yoga and Meditation
� Best when they ar e practiced as par t of an
overall healthy lifestyle:
± Good diet
± Aerobic exercise
± No smoking
± Safe dr inking
± Wear ing seatbelts
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How to get started
� Books - hundreds
� Videos - many� Classes ± all over San Antonio
� http://www.texasyoga.com/dir ector ies/san
_antonio_ yoga.html
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http://www.santosha.com/asanas/index.html
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Conclusion
� Yoga can be valuable to:±You
±Your patients
� WE can write prescriptions forhealthy lifestyles (not just
medications)±Diet and exercise
±Smoking cessation
±Yoga