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What is Yoga?
What is the evidence that Yoga has health
 benefits?
How do I use and prescribe Yoga as a
 physician?
 5000 years old
 founded in India
 The word “Yoga”
  means “yoke” or
  “unity” translated from
  Sanskrit, the classical
  language of India.
 It also means
  “discipline” or “effort.”
Yoga requires you
 to make an effort
 to unify your body
 and mind.
You do this by
 concentrating your
 awareness on your
 physical body
 through breathing
 and postures.
Meditation is a technique in which the
 meditator seeks not only to reach a deep
 state of relaxation, but to quiet the mind.

The mind is a chattering monkey that one
 tries to make quiet with meditation.
Meditation seeks a state of enlightenment,
a freedom from the tyranny of our worries.
The approach to Yoga that focuses on postures is called
 Hatha (haht-hah) Yoga.
Ananda
Ashthanga
Bikram
Iyengar
Kundalini
Sivananda
Viniyoga
Abdominal breathing
Sends a fax to the brain to relax


Close your eyes
Put your hand on your belly
Imagine …..
 Asanas are the heart of Hatha Yoga
 Stretching that maintains and enhances
  flexibility
 Many poses are a form of isometric
  strengthening exercise, which involve
  the contraction of muscles without
  moving the joint.
 Isometric exercise is often used in
  physical therapy for the rehabilitation of
  injured joints.
Focused
Mantra
Walking
is a technique in which you direct your
 awareness onto something.
 a picture or statue of a deity
 a universal principle such as compassion or
  forgiveness
 or the syllable OM, the famous Hindu
  mantra.
In Sanskrit, the “man” in mantra means “to
 think,” and “tra” suggests instrumentality.
Mantra literally means an instrument of
 thought.
You repeat a word, phrase or sound in
 order to transcend the constant distractions
 of the mind.
 Meditation is a conscious mental
  process that induces a set of integrated
  physiologic changes termed the
  “relaxation response” by Herbert
  Benson.
 Functional magnetic resonance imaging
  (fMRI) was used to identify and
  characterize the brain regions that are
  active during a simple form of
  meditation.
   Significant signal increases were observed in
    the dorsolateral 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 meditation
    activates neural structures involved in
    attention and control of the autonomic
    nervous system.
     Neuroreport. 2000 May 15;11(7):1581-5. Functional
      brain mapping of the relaxation response and
      meditation. Lazar SW,…, Benson H.
Decrease in Beta-wave activity after meditation
There is good scientific evidence
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
Stretching for
 flexibility
Improved Strength
Improved Balance
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.
Herbert Benson,
 MD
founding President
 of the Mind/Body
 Medical Institute
Associate Professor
 of Medicine,
 Harvard Medical
 School
 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 form of meditation.
Whether you fight or run, your sympathetic
 nervous system will be on overdrive
 pumping out nor-epinephrine.
What are the physiological effects of this
 process?
Why would you not want this to be a chronic
 state of existence?
Yoga and meditation decrease this
 sympathetic tone and reduce feelings of
 stress and anxiety
Many modern health problems are
 worsened by stress and anxiety
Yoga works to decrease sympathetic tone
 Significantly greater reductions in
  psychological distress, anxiety, and
  perceived stress were found in the
  experimental group who had learned
  the relaxation response.
   The evaluation of a mind/body intervention
    to reduce psychological distress and
    perceived stress in college students.
   Deckro GR, …, Benson H.
   J Am Coll Health. 2002 May;50(6):281-7.
Yoga to improve quality of
life of patients with cancer
Persons with breast or prostate cancer
 were taught to use Yoga.
Significant improvements were seen in
 overall quality of life, symptoms of
 stress, and sleep quality.


 Carlson LE, et al. Mindfulness-based stress reduction in relation to quality of life,
   mood, symptoms of stress … in breast and prostate cancer outpatients.

 Psychoneuroendocrinology. 2004 May;29(4):448-74
   Evaluation of a yoga based regimen for
    treatment of osteoarthritis of the hands.

   The Yoga program was effective in
    providing relief in hand osteoarthritis.

      Garfinkel MS, et al. J Rheumatol. 1994
       Dec;21(12):2341-3.
 “Current evidence shows significant
  short-term benefit from oral steroids,
  splinting, ultrasound and yoga.”

 Cochrane review, Issue 1, 2004.

 Garfinkel, et al. Yoga-Based
  Intervention for Carpal Tunnel
  Syndrome. A Randomized Trial. JAMA.
  1998
Health Conditions in which Yoga
may help heal or treat
   Arthritis              PMS and Menstrual
   Allergies               Discomfort
   Asthma                 Menopause
   Hypertension           Pain of the Back,
   Coronary Artery         Hips, Knees
    Disease                Depression &
   Irritable Bowel         Anxiety
    Syndrome
   Heartburn (GERD)
                           Substance Abuse
   Constipation           Skin Disorders
   Tension Headaches      Chronic Fatigue
    and Migraines           Syndrome
                           Overweight
                           Sleep Problems
Treating Back Pain with Yoga

Similarities to PT
 Williams flexion exercises
 McKenzie extension exercises
Addition of breathing and relaxation
As forms of medical treatments do Yoga
 and Meditation meet standards for being
 safe and effective?

Safer than most medications
 No adverse effects such as allergic reactions,
   liver or kidney damage as seen with some
   medications.
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 – 80 year old
 yoga teacher in San Antonio
 We have reviewed some studies
    showing effectiveness 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
Best when they are practiced as part of an overall healthy
  lifestyle:
  Good diet
  Aerobic exercise
  No smoking
  Safe drinking
  Wearing seatbelts
Books - hundreds
Videos - many
Classes – all over San Antonio
http://www.texasyoga.com/directories/san_antonio_yoga.html
Conclusion
Yoga can be valuable to:
 You
 Your patients


WE can write prescriptions for healthy
 lifestyles (not just medications)
 Diet and exercise
 Smoking cessation
 Yoga
Yoga

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Yoga

  • 1.
  • 2. What is Yoga? What is the evidence that Yoga has health benefits? How do I use and prescribe Yoga as a physician?
  • 3.  5000 years old  founded in India  The word “Yoga” means “yoke” or “unity” translated from Sanskrit, the classical language of India.  It also means “discipline” or “effort.”
  • 4. Yoga requires you to make an effort to unify your body and mind. You do this by concentrating your awareness on your physical body through breathing and postures.
  • 5. Meditation is a technique in which the meditator seeks not only to reach a deep state of relaxation, but to quiet the mind. The mind is a chattering monkey that one tries to make quiet with meditation.
  • 6. Meditation seeks a state of enlightenment, a freedom from the tyranny of our worries.
  • 7. The approach to Yoga that focuses on postures is called Hatha (haht-hah) Yoga. Ananda Ashthanga Bikram Iyengar Kundalini Sivananda Viniyoga
  • 8.
  • 9. Abdominal breathing Sends a fax to the brain to relax Close your eyes Put your hand on your belly Imagine …..
  • 10.  Asanas are the heart of Hatha Yoga  Stretching that maintains and enhances flexibility  Many poses are a form of isometric strengthening exercise, which involve the contraction of muscles without moving the joint.  Isometric exercise is often used in physical therapy for the rehabilitation of injured joints.
  • 12. is a technique in which you direct your awareness onto something. a picture or statue of a deity a universal principle such as compassion or forgiveness or the syllable OM, the famous Hindu mantra.
  • 13. In Sanskrit, the “man” in mantra means “to think,” and “tra” suggests instrumentality. Mantra literally means an instrument of thought. You repeat a word, phrase or sound in order to transcend the constant distractions of the mind.
  • 14.  Meditation is a conscious mental process that induces a set of integrated physiologic changes termed the “relaxation response” by Herbert Benson.  Functional magnetic resonance imaging (fMRI) was used to identify and characterize the brain regions that are active during a simple form of meditation.
  • 15. Significant signal increases were observed in the dorsolateral 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 meditation activates neural structures involved in attention and control of the autonomic nervous system.  Neuroreport. 2000 May 15;11(7):1581-5. Functional brain mapping of the relaxation response and meditation. Lazar SW,…, Benson H.
  • 16.
  • 17. Decrease in Beta-wave activity after meditation
  • 18. There is good scientific evidence 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
  • 19. Stretching for flexibility Improved Strength Improved Balance
  • 20. 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.
  • 21. Herbert Benson, MD founding President of the Mind/Body Medical Institute Associate Professor of Medicine, Harvard Medical School
  • 22.  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 form of meditation.
  • 23. Whether you fight or run, your sympathetic nervous system will be on overdrive pumping out nor-epinephrine. What are the physiological effects of this process? Why would you not want this to be a chronic state of existence?
  • 24. Yoga and meditation decrease this sympathetic tone and reduce feelings of stress and anxiety Many modern health problems are worsened by stress and anxiety Yoga works to decrease sympathetic tone
  • 25.  Significantly greater reductions in psychological distress, anxiety, and perceived stress were found in the experimental group who had learned the relaxation response.  The evaluation of a mind/body intervention to reduce psychological distress and perceived stress in college students.  Deckro GR, …, Benson H.  J Am Coll Health. 2002 May;50(6):281-7.
  • 26. Yoga to improve quality of life of patients with cancer Persons with breast or prostate cancer were taught to use Yoga. Significant improvements were seen in overall quality of life, symptoms of stress, and sleep quality.  Carlson LE, et al. Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress … in breast and prostate cancer outpatients.  Psychoneuroendocrinology. 2004 May;29(4):448-74
  • 27. Evaluation of a yoga based regimen for treatment of osteoarthritis of the hands.  The Yoga program was effective in providing relief in hand osteoarthritis. Garfinkel MS, et al. J Rheumatol. 1994 Dec;21(12):2341-3.
  • 28.
  • 29.  “Current evidence shows significant short-term benefit from oral steroids, splinting, ultrasound and yoga.”  Cochrane review, Issue 1, 2004.  Garfinkel, et al. Yoga-Based Intervention for Carpal Tunnel Syndrome. A Randomized Trial. JAMA. 1998
  • 30. Health Conditions in which Yoga may help heal or treat  Arthritis  PMS and Menstrual  Allergies Discomfort  Asthma  Menopause  Hypertension  Pain of the Back,  Coronary Artery Hips, Knees Disease  Depression &  Irritable Bowel Anxiety Syndrome  Heartburn (GERD)  Substance Abuse  Constipation  Skin Disorders  Tension Headaches  Chronic Fatigue and Migraines Syndrome  Overweight  Sleep Problems
  • 31. Treating Back Pain with Yoga Similarities to PT Williams flexion exercises McKenzie extension exercises Addition of breathing and relaxation
  • 32. As forms of medical treatments do Yoga and Meditation meet standards for being safe and effective? Safer than most medications No adverse effects such as allergic reactions, liver or kidney damage as seen with some medications.
  • 33. 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 – 80 year old yoga teacher in San Antonio
  • 34.  We have reviewed some studies showing effectiveness 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
  • 35. Best when they are practiced as part of an overall healthy lifestyle: Good diet Aerobic exercise No smoking Safe drinking Wearing seatbelts
  • 36. Books - hundreds Videos - many Classes – all over San Antonio http://www.texasyoga.com/directories/san_antonio_yoga.html
  • 37. Conclusion Yoga can be valuable to: You Your patients WE can write prescriptions for healthy lifestyles (not just medications) Diet and exercise Smoking cessation Yoga