Applying Yoga Therapy in Healthcare

ARTICLE:

Yoga has evolved as one of the most reliable, authentic, and efficient health care systems available in society today.  Most people believe that daily practice of Yoga and maintenance of a yogic lifestyle produces better health benefits than does regular exercise. This is due to yogic activation of the relaxation response and parasympathetic tone. These yogic health benefits are useful as therapy for stress-related high sympathetic tone causing chronic lifestyle-related dis-eases like truncal obesity, diabetes, hypertension, heart disease, dyslipidemia, chronic lower back pain, arthritis, and asthma.

I. The State of Yoga Therapy Today

The expanding field of Yoga Therapy includes a wide variety of practitioners and organizations.  It has become part of Integrative Medicine, another sub-specialty of the Internal Medicine department. Fifteen years back, 3 out of 140 medical schools in the U.S. had a department of Integrative Medicine; now about 100 medical schools have the sub-specialty. About 65 medical school teaching programs have fellowships in Integrative Medicine, and 26 of them have been approved by the American Board of Integrative Medicine.  Today, tertiary medical centers like the renowned Cleveland Clinic are using Yoga as therapy in their Lifestyle 180 Program by offering Yoga classes daily to their patients. Most of the health care centers in the U.S. have incorporated Yoga Therapy in their treatment protocol. In 1998, the National Institutes of Health (NIH) established a full-strength federal agency, the National Center for Complementary and Alternative Medicine (NCCAM), and included Yoga as a part of CAM treatment. In December of 2014, Congress changed the name from NCCAM to NCCIH (National Center for Complementary and Integrative Health) because the Yoga practice outcome is the maintenance of health.  The NIH website currently lists 324 ongoing clinical trials for Yoga as therapy, all funded by NIH grants.  On May 19-23, 2008, the NIH premiered its first annual Yoga Week, highlighting the science, research, and practice of Yoga. The PubMed (U.S. National Library of Medicine) website lists over 4,500 journal citations about Yoga Therapy.  The International Association of Yoga Therapists (IAYT), a non-profit organization, spans a twenty-nine year history and serves as a professional organization for over 6,000 Yoga therapists from 50 countries. The IAYT started self-monitoring of the Yoga Therapists, with introduction of standards in 2012, accreditation of Yoga Therapy schools in 2014, and certification of Yoga Therapists in 2016. Today there are around 40 accredited Yoga Therapy schools out of over 200 member schools and around 3,700 certified Yoga Therapists.  IAYT publishes a peer-reviewed annual journal, International Journal of Yoga Therapy, and a tri-annual publication, Yoga Therapy Today. In 2007, Dr. Timothy McCall published the first Yoga Therapy book, Yoga as Medicine, with references of health conditions benefited by Yoga. Recently multiple textbooks have been published for Yoga Therapy students, like Yoga Therapy and Integrative Medicine, The Principles and Practice of Yoga in Health Care, and Research Based Perspectives on the Psychophysiology of Yoga. My book Yoga Therapy, Ayurveda, and Western Medicine: A Healthy Convergence, published as textbook in 2017, was very well received by the Yoga Therapy and Ayurveda Yoga Therapy community. Large number of books were sold within a few months, and another publisher started marketing the book. There is no other book that addresses these three healing modalities together.  A recent survey in 2016 by Yoga Journal and Yoga Alliance, a non-profit group with 95,000 members in 145 countries that maintains a registry of Yoga teachers and schools, found that 36.7 million Americans are practicing Yoga, and 80 million say they will try Yoga in the future. Yoga is a 16 billion-dollar industry. An August 2009 survey conducted by the Pew Forum on Religion and Public Life found that 23% of Americans believe Yoga to be “a spiritual practice with health benefits.” In the United States, Yoga is visible on the covers of Time and Newsweek magazines, in iPhone applications, and in the advertisements of McDonald’s, Wal-Mart, various hotel chains, and different companies.  Video game maker Nintendo brings Yoga into people’s homes with their popular Wii Fit program to improve balance and flexibility.

Western Medicine defines health as the absence of dis-ease, whereas in yogic tradition dis-ease is defined as the absence of vibrant health. Yoga Therapy is not dis-ease-specific, but rather Yoga’s therapeutic benefit is derived from a general target to maintain good health.

II. The Philosophy of Yoga Therapy

The term “Yoga” is derived from the Sanskrit word yuj, meaning yoke or union, specifically the union of body, mind, and spirit. Yoga views the body as the physiological function of different systems that is treated by allopathic medicine, the mind as the psychology and perception through the five senses treated by psychiatry, and the spirit as the impact of the beliefs and philosophy on our physical body and treated by integrative medicine. These three units can be analogized to cyber-language terms, where the body is the hardware, the mind is the software, and the spirit is the programmer. The mind (the software) controls the physical body (the hardware). By controlling the mind through yogic practice, one can control the physical body and its ailments. In yogic tradition, health is defined as a balance between body, mind, and spirit. By uniting body, mind, and spirit one achieves health and in turn resists dis-ease. Western Medicine defines health as the absence of dis-ease, whereas in yogic tradition dis-ease is defined as the absence of vibrant health. Yoga Therapy is not dis-ease-specific, but rather Yoga’s therapeutic benefit is derived from a general target to maintain good health. Yoga Therapy simultaneously treats a dis-ease (rogir chikitsa) and maintains one’s health (swastha rakhsa).  This maintenance of the health or personalized lifestyle change is used in Western Medicine as adjuvant therapy.

Yoga Therapy is the process of empowering individuals to progress towards improved health and well-being through the application of the philosophy and practice of Yoga. This yogic philosophy is outlined in the Yoga Sutras of Patanjali, a foundational ancient treatise that describes Yoga as “the cessation of the fluctuations of the mind” (yoga chitta vritti nirodha). The practice of Yoga is Patanjali Ashtanga Yoga (eight limbed Yoga), a systemic practice of eight limbs to attain the transformative union of body, mind, and spirit in the eighth limb, called samadhi.  The first two limbs, yama (social disciplines) and niyama (personal disciplines), control the attitude and the mind. The third limb, asana, is the relaxed external and internal alignment of the physical body while the fourth limb, pranayam, controls one’s breathing to transform the mind. Pratyahara, the fifth limb, and controls the five senses and unites them with the mind. The sixth limb, dharana, advocates single-pointed focus on one object to avoid other thoughts in order for one’s prana, or life force, to unite with the mind.  The last practice (the seventh limb) is dhyana, or meditation, where a thoughtless mind connects to our individual spirit or soul.

III. Application of Yoga Therapy to the Individual Through Asanas, Pranayam and Meditation

Yoga Therapy is not evidence-based medicine, but rather, practice-based evidence.  A standard template or one-size-fits-all strategy does not work for Yoga; it is individualized to each person and requires personalized lifestyle changes.  Studies have shown lifestyle changes through Yoga can be better than drugs in helping people deal with various ailments. Yoga Therapy is a strong medicine, but it is also a very slow-working medicine. It is very addictive, transformative, and synergistic with other therapies and cleanses the mind and body. The therapeutic effects are achieved through a relaxation response that activates the body’s parasympathetic nervous system which calms the mind and body and also aids in digestion. The relaxation response causes a slower heart rate, decreased blood pressure, slow and steady respiration, improved vital capacity, and longer breath-holding power.

Yoga poses, or asanas, go through three stages.  Initially, the muscles contract during the arambha stage, or the beginning.  By staying in the pose for an extended period of time with the eyes closed and continuous yogic breathing (effortless exhalation time that is close to double the inhalation time), the muscle contractions become steady (sthiti). During the final stage of surrender (visharjana), there is profound relaxation of the muscles and ligaments. This relaxation produces external and internal alignment, relaxation of the blood vessels of vital organs with proper perfusion, and proper physiological function of the systems. Asanas also systematically place pressure on the internal organs with massage and toning. The daily practice of asanas gives the physical body a proper shape, making it flexible and energetic.

The most important component of Yoga Therapy is pranayam (controlled breathing). Normally, the total lung capacity in one’s body is around 5.5 liters with 1.5 liters of residual volume. This gives our lungs about 4 liters of vital capacity, but the typical tidal volume, or volume of air displaced between normal inhalation and exhalation without extra effort, is only 500 milliliters in most people. That leaves 3.5 liters of carbon dioxide and other toxic gases sitting in the lungs. By deep breathing and through prolonging the exhalation through pranayam, one removes these toxic gases from the lungs and brings more oxygen to the tissue. This oxygen then combines with glucose (the end product of metabolism to form carbon dioxide and water) and releases ATP, the energy for our bodies. This aerobic glycolysis produces energy that acts as a dis-ease-fighting agent. On the other hand, when oxygen is not adequate, the glucose metabolism goes through anaerobic glycolysis, producing lactic acid and pain-producing substances, which are pre-cursors to lifestyle-related dis-eases.

Inhalation is sympathetic and exhalation is parasympathetic. By prolonging exhalation more than inhalation, the parasympathetic nerve activation described above takes place. Yoga philosophy believes that by controlled breathing the life force, or prana, flows freely throughout the body. This prana is the healing power and medicine vital to one’s health and well-being. Bringing more oxygen to the tissue, massaging internal organs, and keeping the mind steady through pranayam achieves prana.  For a good outcome of pranayam, it should be done with vidhi (method), samaya (timing), sankalpa (determination), and siddhi (surrender).

While genetic predisposition may be a “loaded gun” for these chronic dis-eases, the “trigger” to the gun is one’s lifestyle. By controlling one’s lifestyle through Yoga practice, one can achieve primary prevention of the dis-ease by preventing the genetic expression from ever taking place.

IV. Scientific and Medical Observations of Yoga Therapy

The therapeutic effect of Yoga is through psycho-neuro-endocrinology. The limbic system of the brain (psycho) is the site of our emotions and mind. The two nuclei, the amygdala and hippocampus, become activated when the mind is controlled through Yoga and the five senses. They send a signal to the hypothalamus (neuro) through neurotransmitters. The hypothalamus then sends a signal to the autonomic nervous system and the pituitary gland (endocrinology). Through a negative feedback cycle, the pituitary gland corrects altered hormonal homeostasis by fixing the system’s abnormalities, not merely its symptoms. The benefits of Yoga are seen even at the cellular level. Every cell contains an infinite wealth of intelligence, discipline, and consciousness. In a dis-eased state, these functions become altered. Yoga brings back the cell functions and promises great hope in curing dis-eases such as cancer by bringing back the intelligence, discipline, and consciousness to cancerous cells.

Most chronic diseases like diabetes, hypertension, and heart disease have an element of genetic predisposition. In order for a dis-ease to manifest, the genetic predisposition has to convert to a genetic expression. This conversion is done through a person’s lifestyle choices called epigenetics, which are completely within one’s control. Therefore, while genetic predisposition may be a “loaded gun” for these chronic dis-eases, the “trigger” to the gun is one’s lifestyle. By controlling one’s lifestyle through Yoga practice, one can achieve primary prevention of the dis-ease by preventing the genetic expression from ever taking place.

In the case of clinical dis-eases, where genetic expression has already taken place, Yoga Therapy can be initiated after the usual and customary treatments to cause genetic suppression, secondary prevention to stop progression, or even to completely reverse the dis-ease. Yoga Therapy can also be used as rehabilitation of a dis-ease by leading to better management of the dis-ease, less pharmaceutical support, and better quality of life. In some cases, Yoga Therapy has been reported as a cure for chronic dis-eases. During hospice care of a terminal patient, pranayam (controlled breathing) can be used to prevent shortness of breath and air hunger. Finally, pregnant women who practice yoga before and during pregnancy require less epidural, pitressin drip, and cesarean sections during delivery than women who do not practice Yoga.

V. Conclusion

In conclusion, Yoga Therapy can be used in Western Medicine to treat chronic dis-eases. Because most chronic endogenous dis-eases present with acute onset, standard evidence-based conventional therapy should be started at that point, along with personal lifestyle modifications through Yoga Therapy. Over time, Yoga Therapy through asanas, pranayam and meditation will improve one’s underlying condition and chronic dependence on medications can be slowly withdrawn, resulting in reduced side effects and improved, dis-ease free, medication-free healthy living.

Select General References