Medical Yoga: The New Frontier

Dr. M. Mala Cunningham, a counseling psychologist and the founder of Cardiac Yoga®, has been at the forefront of developing specialized Yoga programs in the areas of chronic pain, heart disease, stress management, and Yoga therapy. In this interview, she discusses her program, issues of competency, and how Yoga teachers can learn to interface more effectively with the medical community.

Integral Yoga Magazine:  Yoga therapy and medical Yoga are becoming increasingly popular. Why?

Mala Cunningham:  The origins of Yoga are based on human and spiritual development. But because Yoga is a system of wellness and vitality, it has evolved further into applications in the medical field and can be used for both prevention and rehabilitation of illnesses and disease.

IYM:  Do you think Yoga teachers, even if they are not working with a special population, need some specialized training?

MC:  The statistics tell us that one out of four people have some form of heart disease. The chances of someone having a person in their class with heart disease is high. So, I think the more training each Yoga teacher has the better. It’s my personal belief that teachers should have every student fill out a basic information form prior to taking their first class. What if someone faints in class? Maybe the person has heart disease, maybe they are hypoglycemic or have another medical condition, or are on medication. If the teacher has no information on that person, they may not know what to do or whom to call.

A student information form can have very basic information: name, phone number, medical condition, any medication, an emergency contact name and number. I also like to include a question about what the student wants to get out of the class. It can help the teacher to gauge expectations and to be aware of these. And, at the most basic level, if you need to cancel a class, you have contact information for your students.

IYM:  It seems that more and more doctors and hospitals are recommending Yoga to their patients.

MC:  That is why I believe Yoga teachers need to know how to interface with the medical community and to have a basic understanding of medical protocol. This is especially important for teachers working with special populations. You need to know how to keep records, how to respond to referrals, and in general, to have basic knowledge about various conditions.

IYM:  Are doctors looking for Yoga teachers with specialized training to work with their patients?

MC:  Doctors and hospitals are not only looking for Yoga teachers who have specialized training but also for Yoga teachers who are certified to work with cardiac patients, cancer patients, and other special populations. Yoga is a growing field and, in the last 10 years, we are applying Yoga to populations we never thought we would serve.

If you are working with special populations it is really important to be competent. This competency builds confidence in both the teacher and the student. For example, heart patients are very educated about their disease. To have a student come in with mitrovalve prolapse, or on medications like Coumadin, and for the teacher to not know what those things mean, does not engender a sense of confidence on either side.

When I am conducting a Cardiac Yoga Teacher Training, I explain to the trainees the importance of knowing side effects of commonly used heart medications. For example, if a heart patient takes their medication at 8 a.m. and they take an 11 a.m. Yoga class, the medication side effects, such as fatigue, dizziness, etc., could reach peak potency during the class. Teachers need to be aware of this.

IYM:  Cardiac Yoga TT is being implemented in hospital settings worldwide. Would you tell us about the program?

MC:  I use the concept “BREAD” as an acronym for describing the components of the Cardiac Yoga program:  Breathing, Relaxation, Exercise/Yoga, Attitude, Diet. I started developing components of this program in the early ‘80s. I had a very good friend who had a heart attack and he had virtually no psychosocial support. I was very interested in what Yoga could do to impact heart disease. I wanted to look at the difference psychosocial support, relaxation, and meditation might have. I started developing programs to address this when I was in graduate school and they continued to grow and unfold.

IYM:  What does the training consist of?

MC:  It’s a 10-day residential program in Yogaville. For health professionals who can’t do a residential program there are 6-day condensed programs offered. Manuals are sent out well in advance, along with study guides. Students are instructed to begin studying before arrival. There are two competency tests during the program; one is on the anatomy and physiology of the heart, the other is on the psychosocial aspects and on the implementation of Yoga.

The curriculum includes a review of mind-body medicine, training in the anatomy and physiology of the heart, psychosocial aspects of heart disease, risk factors for heart disease, the adaptation of Yoga for heart patients, healing through Yoga, meditation, guided imagery, pranayama, facilitating support groups for heart patients, teaching and designing classes, and marketing Cardiac Yoga.

There is a cardiologist on the faculty who serves as medical director for the program. We include a tour of the University of Virginia’s Heart Center so students are exposed to cardiac rehab, and diagnostic interventions such as stress testing, nuclear cardiology, and echocardiography. Students also learn from heart patients, who come in to share their stories and experiences of heart disease.

IYM:  To what do you attribute the increased interest in Yoga by the medical community?

MC:  I think they are recognizing the therapeutic and medical benefits of Yoga and how the relaxation response can help promote health and vitality. Additionally, these programs are cost-effective for hospitals. I am also finding that between 50-60 percent of those who take Cardiac Yoga Teacher Training are medical personnel—doctors, cardiac rehab nurses, directors of rehab. I get e-mails all the time from hospitals asking about our certification for their Yoga teachers and therapists.

IYM:  Do you think this is a new direction for Yoga teachers?

MC:  The Yoga field is getting saturated with Yoga teachers. Charlottesville, Virginia, with a population of about 45,000, has five Yoga centers and numerous other places Yoga is offered—gyms, spas, community centers, the University. The new frontier of Yoga application is in medical settings. We need more competency-based training programs, with integrated curricula, that interface with the medical community.

I feel proud to say that the Integral Yoga Academy is on the cutting edge. We offer specialized trainings for teachers to work with cancer patients, children with special needs, heart patients, and so on. All these programs are excellent. The curricula are
well put together and we interface with the medical community in a comprehensive and professional way.

IYM:  What do you see for the future of both the Integral Yoga Academy and Yoga in general?

MC:  We can do more specialized trainings. For example, I think the whole field of mental health needs closer examination. We are beginning to study the impact of Yoga, meditation, and relaxation on mental health concerns. Yoga teachers can learn to be more aware of students who are dealing with depression or panic attacks.

Being a Yoga teacher in the 21st century is different than it was in the 1970s. People have a more sophisticated knowledge of Yoga. We have taken Yoga into specialized areas. Some 20 million people are taking Yoga classes and some who need specialized attention. It’s important that Yoga teachers have access to continuing education courses that include medical and mental health issues.

IYM:  What is your view of Sri Gurudev’s influence on the field of Yoga and medicine?

MC:  Sri Gurudev spearheaded bringing Yoga into the 21st century. He was on the cutting edge of bringing Yoga into the modern world. He brought Yoga not just into the medical community but into our corporate structure, into our educational systems, and to the general public. Gurudev laid down a strong foundation for a change in consciousness in humanity with the application of Yoga in a variety of settings.

All paths of Yoga have value to the practitioners. What specifically draws me to Integral Yoga is the emphasis on body, mind, and spirit. I am profoundly aware of the emphasis on selfless service that is a strong part of the Integral Yoga tradition. For me, the integration of spirituality with Yoga is an important component. On a personal level, I feel Sri Gurudev’s blessings all the time and his guidance in terms of the direction I should go in. It’s hard to find words to express the gratitude I feel.

About M. Mala Cunningham, PhD
Dr. Cunningham is a leading speaker, author, and educator in the field of Mind-Body Medicine and Health Psychology.  She is the President of Positive Health Solutions and is the Founder and Director of the renowned training program, Cardiac Medical Yoga.

Reprinted from Integral Yoga Magazine, Summer 2004

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