TrainingReport by Nancy O’Brien

Yoga for Arthritis Teacher-Training Intensive with Steffany Haaz ith a long-held dream to become many research studies to have a positive “the Dean Ornish of arthritis” effect on quality of life. It's an effect that, as and seven years of rigorous Haaz points out, extends beyond class- research under her belt, Steffany Haaz, PhD, es and takes hold in people's lives. “People WRYT 500, convened her first Yoga for Arthri- with arthritis may enjoy Yoga more than tra- tis Teacher-Training Intensive last fall in Bal- ditional forms of exercise, and . . . are more timore. Over three days, she would provide likely to continue,” Haaz says. her first seven participants with a solid For the 50 million adults in the United grounding in sixteen evidenced-based class- Participant and Baltimore Yoga teacher Janet Indresano States with arthritis, or any of its related con- es, tailored to safely and effectively impart relaxes in a supported wide-angle forward bend. ditions such as Crohn's disease and gout, Yoga's benefits to people living with arthritis symptoms can range widely from day to day and its related conditions. present. However, OA, which affects 21 mil- and year to year. Yoga's compassionate The foundation of this teacher-training lion people, cannot be cured. Safe movement approach in meeting each individual with intensive was the sixteen-class, eight-week and exercise such as Yoga and stress reduc- full acceptance in each moment is well-suit- Yoga for Arthritis series: the protocol used tion are often recommended by healthcare ed to this variability. during seven years of research conducted at providers to address symptoms. THE INTENSIVE Johns Hopkins University. The intensive The second major form of the disease, entitles the participants, upon successful rheumatoid arthritis (RA), is an autoimmune Overview completion, to use these sixteen sequential condition affecting 1.2 million people in the classes to teach this series, using a manual United States. Its symptoms, such as severe Each day of the intensive in the well- that covers the material contained in those fatigue and pain, commonly flare up and equipped and serene yama studio (Yoga, classes. abate, with stress seen as a major factor. & Meditation Arts) began with a Joining Haaz in the training were two Recent advancements in medical treatment Yoga class taught by Haaz in a spirit of self- guest speakers: Heather Keller, RN, BSN, 500 have resulted in some effective medications care that was a recurrent theme of the train- E-RYT, who taught two eight-week series as for helping to manage the disease; but again, ing. This set the tone as the days moved on, part of the study; and Marina Tompkins, safe movement and stress-reduction strate- with lectures and group discussions backed director of an adult day program, who has gies are recommended by health-care by PowerPoint presentations and handouts. rheumatoid arthritis and was a student in providers to help people deal with their Topics covered included anatomy, the caus- one of Haaz's Yoga for Arthritis series. arthritis self-care. es and symptoms of arthritis, research The training required a minimum Yoga results, how specific yogic practices and Alliance registration of RYT-200, and the Haaz and the research team at Johns Hop- principles relate to the conditions common participants were all committed Yoga teach- kins University found that the specific bene- to the disease, and how to reach the arthritis ers, from 30-somethings to 50-somethings, fits of this sixteen-class Yoga series for those community. steeped in various Yoga traditions and orien- with arthritis included: The main focus throughout the inten- tations, including Integral Yoga, therapeutic sive was hands-on exposure to the Yoga for and restorative Yoga, Iyengar Yoga, and • A statistically significant improvement in Arthritis series so that participants were Bihar School of Yoga. overall physical health, flexibility, and bal- equipped to bring it back to their communi- ance. ties after completion. The first ten classes of BACKGROUND • A significant reduction in symptoms of the series offer a basic structure that begins depression and improvement in positive with discussion and ten minutes of warm- affect (more joy and happiness). ups tailored to individual needs, followed Arthritis, which includes 100 different condi- • A significant improvement in pain symp- by fifteen to twenty minutes of prac- tions under its umbrella, is currently the toms and, for those with RA, a significant tice, gradually introducing standing (when nation's leading cause of disability, affecting difference in the number of tender and possible) and sitting postures with any about 50 percent of Americans, with increas- swollen joints when compared with con- props andsavasana modifications needed; ten min- es projected over the next 30 years as baby trol subjects receiving the usual medical utes of (relaxation pose); and five boomers age. There is a growing need for care. minutes of a closing that includes introduc- Yoga teachers with training to serve this tions to various awareness and meditationasana population. (Study results are included in an article enti- practices. Key to adapting each of the , Medication, surgery, and other proce- tled “Yoga for Arthritis: A Scoping Review,” relaxation, and meditation practices includ- 1 dures can reduce symptoms in the most co-authored by Haaz and S. J. Bartlett) ed in these classes is the broad range of rec- common form of the disease, osteoarthritis ommended modifications, often with props, (OA), which is usually caused by wear and Perhaps most important for those living with that are demonstrated,(continued illustrated, on page and, 35) tear on the joints, often with inflammation these conditions, Yoga has been shown by most importantly, Spring 2011 YogaTherapyToday 34 TrainingReport continued experienced during this intensive. The adap- experiences. Do a Facebook search for “Yoga tations address specific conditions such as for Arthritis” and see what the intensive's wrist pain (a padded wedge) or overall participants are offering. weakness (chair and one-on-one support). FUTURE DIRECTIONS The remaining six classes use the same basic structure but focus on some specific topics and concerns. There is a class on sciatica, for Haaz will be teaching a five-day Yoga for instance, and one that explores using a wall Arthritis Teacher Training Intensive at Yogav- for those who need the support in such poses ille, Integral Yoga's Satchidananda in as half-moon or a seated twist. Another class A wedge beneath the mat can mean more support and Buckingham, VA, in June of 2011. Plans are is structured to prepare teachers offering the cushioning and less pain for a person with arthritis. also in the works for a three-day intensive at series to give their students the opportunity Integral Yoga Institute in New York City. (I to lead a session. Each of the sixteen classes groundwork for deeper understanding of am planning to assist at both intensives.) includes recommended homework for the how to teach to this population. As Haaz Both trainings qualify those who suc- yoga teachers' students, with suggested - says, “This population has knowledge. Your cessfully complete it for 30 hours of credit cles included in the teacher and student man- role is not to fix them, but to provide a posi- with the Yoga Alliance. Student manuals uals on topics such as meditation and creat- tive experience in a safe way, to allow the and the use of the logo are also available ing a personal practice. pain to be.” With arthritis, often, pain is the when participants present their own Yoga Day-by-Day fact, the truth of an individual's experience. for Arthritis series. Day One: This day also featured the ultimate in The initial seven years of this research The first day laid the foundation, the intensive's multiplatform, multisensory was funded in part by the Arthritis Founda- with one of the first assignments—practice presentations. Starting in small groups, then tion and the National Center for Complemen- classes—adding the incentive of perform- reuniting for each group's report and a tary and Alternative Medicine. The next step ance evaluation to the training. Each partici- whole-group discussion, we explored the to further validate the research findings is for pant, as a requirement for course comple- dramatic web-based comics documenting another researcher or researchers to conduct tion, was to practice-teach one of the sixteen author Sara Nash's experiences with Yoga additional trials on how these sixteen classes, 2 Yoga for Arthritis classes outlined and illus- and RA. which were presented in a medical institu- trated in the teachers' manual, sometimes Day Three: tion, translate into a community setting. with a partner. The rest of us, as “students,” intensiveThis day gave real meaning to To any interested researchers, Haaz would role-play, taking on the symptoms the word , with emotions, informa- says, “Email me!” ([email protected]). and challenges we would learn about in tion, and experience all heightened by the As therapeutic Yoga steadily makes other parts of the intensive. awareness that this was the final day of our inroads toward bringing Yoga to individuals The day continued with explorations on training. After the morning Yoga class, fea- who, research shows, stand to benefit so pro- why Yoga works with arthritis, a refresher on turing some background Beatles music, the foundly, the prospect of a growing number anatomy, and a detailed rundown on the day included discussions on teaching strate- of Yoga teachers equipped to safely teach research behind the series that allowed the gies for classes of mixed abilities, two more some of the millions with arthritis isY indeedTT nonresearch types among us to be able to practice classes, evaluations, a beautiful clos- hard-won progress to be celebrated. understand the charts and statistics and pro- ing ritual, and, on top of all that, guest-speak- References fessionally communicate the results in health- er Tompkins, who shared her moving story 1. Haaz, S., & Bartlett, S. J. (2011). Yoga for arthritis: A care settings. Guest speaker Keller told of the of finally being correctly diagnosed after scoping review. Rheumatic Disease Clinics of North initially daunting prospect-and ultimately years of struggling with the knock-you-to- America, 37(1), 33-46. Abstract retrieved from life-transforming satisfaction-of working your-knees condition of RA—a story of the ncbi.nlm.nih.gov/pubmed/21220084. with people living with these conditions. gratitude one young woman feels having 2. Nash, S. (N.D.) Single in the city with rheumatoid found her path of transformation in one of arthritis . . .Hello Baltimore! (J. Samborski, illus.). Day Two: HealthCentral. Retrieved December, 2010, from The second day included the first the research study's Yoga for Arthritis series. healthcentral.com/rheumatoid-arthritis/sara-nash- two practice classes that each of the partici- Tompkins's story, and her powerful per- comics-baltimore.html. pants had been assigned to present; a discus- sonal presence on that last day,allowed us as Nancy O'Brien (nancy- sion on the difficulties faced by those living Yoga teachers to clearly see the value of obrienYoga.com), a with RA; and a brainstorming session on learning as much about arthritis as we can. Yoga teacher and well- how to reach and serve this community that “You need to have an instructor who meets ness writer, editor, and included record-keeping, questionnaires, you where you are,” Tompkins said. “You speaker who specializes and outcome-measure strategies. need to have someone who is asking, 'Is in mind-body practices The day continued with one of the there a pain here?' Someone who says, 'We're for elders and those training's most illuminating segments: all in different places; there's never any rush dealing with health “Application of Yogic Principles.” The pres- for anything.' That's important.”sangha challenges, last wrote entation used the structure of the eight limbs By the closing ceremony, a (com- for this publication of Yoga to present issues likely to arise in munity) had formed. The bond led to the “Our Best Defense,” about Bethesda Naval teaching this series. Looking at arthritissatya in creation of a Facebook group where partici- Hospital's plans to bring a full-time Yoga thera- the context of (nonharming) or pants and future trainees can share informa- pist on staff at a primary-care clinic. (truthfulness), for example, created the tion, marketing materials, photos, links, and 35 YogaTherapyToday Spring 2011