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Health Bulletin - 3

Recent survey shows that there are currently over 20 million people practicing yoga daily in the US. Yoga clinics have become ubiquitous. The current popularity of yoga is unprecedented and further increasing worldwide. Purpose of this article is to highlight the scientific basis for the recent popularity of yoga and recommend you to practice it for better health benefits. Details of various forms of yoga and their mechanisms of action are out of scope of this article.

Yoga and Health: Review of evidence

Hygiene refers to practices performed for the preservation of health. We adopt variety of practices for personal hygiene, such as body wash, brushing and flossing of teeth, sleep, exercise etc.We are all taught various hygiene practices since elementary school and practice as a society. However, a systematic psychological health education is lacking in schools and society. Harvard researcher Dr. Khalsa rightly points out that we are a society raised without the most effective self-care and preventive techniques necessary to deal with stress, emotion, attachment, grief, tension, and the wide array of associated physical symptoms [1]. Consequently, we are burdened with relatively high levels of dysfunctional attitudes, maladaptive behaviors, distress, and mood disturbance, as well as lower sense of well-being and impaired quality of life - all of which can lead to or exacerbate medical and psychiatric conditions.

Yoga practice is associated with health and well-being. Yoga procedures have been used for improving general well-being for ages in India. Yoga version as practiced in the West integrates asanas (postures), pranayama (breathing exercise) and meditation. Multiple research studies have been conducted in the East and the West to evaluate the effectiveness of yoga on physical and mental disorders. It is significant that yoga proved to be effective in number of cases including positive interpersonal relationship, drug dependency, job perfection and job satisfaction, cardiovascular disease risk reduction, fibromyalgia, depression, attention deficit disorder, cancer survival, chemotherapy tolerance and side effects, smoking cessation, chronic pain, anxiety, migraine, blood pressure and heart failure, emphysema and chronic diseases. Few research reports are described below.

Sudarshan Kriya Yoga (SKY), taught by The Art of Living Foundation, has been widely used across many cultures (over 6 million people worldwide), it follows a reproducible sequence, and both research and clinical experience demonstrate that it significantly alleviates stress, anxiety and depression. Dr. Brown from Columbia College of Physicians and Surgeons, New York, and Dr. Gerbarg from New York Medical Center, NY, have conducted a systematic review of published body of research and proposed aneurophysiologic theory for the efficacy of SKY [2]. They have attempted to develop a neurophysiologic integration bybreaking down different breathing practices into their commonelements and applyingresearch from related fields suchas polyvagal theory and vagal nerve stimulation, to enhance our understanding on how SKY works.

Dr. Steinhubl (Scripps Translational Science Institute) and his colleagues studied the effect of meditation in 40 subjects. They utilizedrecently available wireless mobile device technology to evaluate the acute cardiovascular and nervous system responses in both experienced and novice meditators during mantra meditation and reported positive results on blood pressure and EEG changes [3].

The fibromyalgia syndrome (FMS), a chronic condition characterized by chronic widespread pain, fatigue, cognitive disturbances, sleep disorders and a high amount of somatic and psychological distress. A systematic review and meta-analysis byLauche and co-workers found that mindfulness-based stress reduction might be a useful approach for FMS patients [4]. Jones and his group also examined the effect of mindfulness in people with fibromyalgia [5]. A total of 4986 respondents represented all 50 states in the United States and 30 countries. They concluded that fibromyalgia patients experience symptoms that may be alleviated by mindfulness interventions.  

Anxiety, stress, and emotional disorders are some of the major health issues without effective treatment methods in the current society. Jerath and co-workers [6] suggest that reversing homeostatic alterations with meditation and breathing techniques, rather than targeting neurotransmitters with medication, may be a superior method to address the whole body changes that occur in stress, anxiety, and depression. They propose that the breathing techniques could be used as first line treatments.

Naveen and his group studied the effect of a well-defined yoga procedure vs. antidepressant medication on depression [7]. There were three groups of patients: medication-alone (n=78); yoga therapy-alone (n=23) and medications + yoga therapy (n=36). The duration of the follow up was 12 weeks. The participants of the yoga were requested to come daily for a period of 10 days to the National Institute of Mental Health and Neurosciences (New Delhi), where a yoga professional taught them the yoga practices. Each session of training/practice lasted 1 hour. The subjects were instructed to continue yoga at home thereafter, but attend one booster training session in the yoga therapy center at the end of the next 2 months. Home practices were monitored by a family member. The study showed that there was a significant reduction in depression scores in patients with depression in all three groups. However, patients receiving yoga with or without anti-depressants had a greater reduction in depression scores than antidepressant alone. There was also a significant positive correlation between fall in depression scores and rise in serum levels of brain-derived neurotrophic factor (BDNF) in yoga-only group. BDNF is a key modulator of neuroplastic changes and has been implicated in the pathophysiology of depression. Decreased serum BDNF levels were observed in patients with depression in comparison with the healthy controls.  

Yoga therapy has been demonstrated to be useful in treatment of negative symptoms and improving the socio-occupational functioning and emotion recognition deficits in antipsychotic-stabilized schizophrenia patients. Oxytocin has been implicated in social cognition deficits in schizophrenia. Jayaram and co-workers assessed the effects of yoga therapy in antipsychotic stabilized schizophrenia patients [8].A total of 43 schizophrenia patients were randomized to yoga group (n=15) or waitlist group (n=28). Patients in the yoga group received training in a specific yoga therapy module for schizophrenia. Patients in both groups were continued on stable antipsychotic medication. Assessments included scale for assessment of positive symptoms, scale for assessment of negative symptoms, socio-occupational functioning scale and tool for recognition of emotions in neuropsychiatric disorders (TRENDS) and plasma oxytocin levels; performed at baseline and at the end of 1 month.The yoga therapy group showed a significant improvement in socio-occupational functioning, performance on TRENDS and plasma increase in oxytocin levels as compared with the waitlist group.

While yoga has been part of Indian culture since ages, collecting evidence for scientific research has been a recent phenomenon. It should be noted that the modern science is still in its infancy in terms of understanding the concept of yoga. Results available so far already suggest that 15-30 min daily practice of yoga has significant health benefits. Dr. Khalsa appropriately calls yoga 'body/mind hygiene' and should be incorporated in to healthcare system [1]. It is well known that several corporations in the US (such as Apple, Google, General Mills, Nike etc.) offer some type of yoga training for senior executives. 'Search inside yourself' is one of the popular course offered at Google.

Finally, although yoga has its origin in Indian culture and religion, it can be practiced secularly [9].

References

[1] Khalsa. Why do yoga research: who cares and what good is it? International Journal of Yoga Therapy (2007) 17: 19-20.

[2] Brown and Gerbarg. Sudarshan Kriya Yogic Breathing in the Treatment of Stress, Anxiety, and Depression: Part I-Neurophysiologic Model. The Journal of Alternative and Complementary Medicine (2005) 11: 189-201, and Part II-Clinical Applications and Guidelines (2005) 11: 711-717.

[3] Steinhubl et al. Cardiovascular and nervous system changes during meditation. Front Hum Neurosci. (2015) 9:145.

[4] Lauche R et al. A systematic review and meta-analysis of mindfulness-based stress reduction for the fibromyalgia syndrome. Journal of Psychosomatic Research (2013) 75: 500-510.

[5] Jones et al. Fibromyalgia Impact and Mindfulness Characteristics in 4986 People with Fibromyalgia.Explore (NY). 2015 Apr 28.

[6] Jerath et al. Self-Regulation of Breathing as a Primary Treatment for Anxiety. ApplPsychophysiol Biofeedback (2015) 40:107-115.

[7] Naveen GH et al. Positive therapeutic and neurotropic effects of yoga in depression: A comparative study. Indian J Psychiatry (2013) 55(Suppl 3): S400-S404.

[8] Jayaram N et al. Effect of yoga therapy on plasma oxytocin and facial emotion recognition deficits in patients of schizophrenia.Indian J Psychiatry (2013) 55(Suppl 3):S409-13

[9] Ernest E. Therapies: yoga (section 3). In: Ernst E, ed. The desktop guide to complementary and alternative medicine. An evidence based approach. Edinburgh: Mosby (2001) 76-78.

[10] Advice on NIH website: https://nccih.nih.gov/health/yoga/introduction.htm

[11] Advice on Harvard website: http://www.health.harvard.edu/mind-and-mood/yoga-for-anxiety-and-depression

Contributors

Vijay Gangula
Chair, Health Committee
Vijay.gangula@gmail.com

Advisory Committee:
Surender Reddy Neravetla M.D., FACS

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