Yoga in Australia: Results of a National Survey

Stephen John Penman GC (Tert. Teach. Learn)

School of Health Sciences Department of Complementary Medicine RMIT University, Melbourne Submitted March 2008

A thesis submitted in fulfilment of the requirements for the degree of Master of Applied Science

Declaration

The candidate declares that

Except where due acknowledgement has been made, the work is that of the candidate alone This work has not been submitted previously, in whole or in part, to qualify for any other academic award The content of this thesis is the result of work which has been carried out since the official commencement date of the approved research program Any editorial work, paid or unpaid, carried out by a third party has been duly acknowledged Ethics procedures and guidelines have been followed

______Stephen John Penman

13/8/09 ______Date

Acknowledgements

Through a process of consultation with the yoga teaching profession in Australia, many individuals and organisations contributed to and supported the Yoga in Australia survey project. Thanks is offered to the following organisations for their support and assistance:

Satyananda Australian Association Yoga Teachers of Yoga in Daily Life Association

Bikram Yoga Australia

The Advanced Diploma of Yoga Teaching at the Council of Adult Education

Dru Shiva Vedanta Gita Yoga and Meditation Centre of Sydney International Meditation Centres Yoga

The Australian College of

EMP Industrial Classical Yoga Magazine (Yoga mats and accessories) Magazine

Special thanks is also offered to the following individuals for their support and assistance:

Professor Marc Cohen of RMIT University for his initiative to conduct the Yoga in Australia survey, his expert supervision, guidance, and patience over four years Swami Samnyasanand (Philip Stevens) for acting as consultant, collaborator, advisor and friend throughout the project Dr Sue Jackson for her collaboration, guidance, editing and friendship Tristan Penman for designing the ‘Write your name in yoga history’ postcard Dr Katherine Sevar for her guidance on medical questions, editing, personal support and encouragement Ma Devi Saraswati for her guidance, trust and providing the support of the Yoga Teachers Association of Australia Di Lucas, Lucille Wood and the people of Gita International Yoga for their personal support and assistance in reviewing the draft survey questions Leigh Blashke for his personal support, and the students of the Advanced Diploma of Yoga Teaching for their assistance in reviewing the draft survey questions Julia Renaud and the people of the Shiva Ashram for their assistance in drafting the meditation questions and reviewing the draft survey questions Sri Jani Baker and the students of the Australian College of Classical Yoga for their assistance in reviewing the draft survey questions Lisa Demos and Louise Prentice, Senior Research Fellows at Monash University, for their assistance in conducting the literature review Maria Vassos for her assistance with data analysis My extended family and close friends for their encouragement and support: Katherine, Tristan, Lachlan, Alex, Jean, Anne, Chris, Lyn, Ria, Zachary and Nathaniel

Table of Contents

List of Tables and Figures ...... 1 Abbreviations ...... 4 Abbreviations ...... 4 Executive Summary ...... 6 1. Introduction...... 8 1.1. A brief introduction to yoga ...... 8 1.2. Defining yoga ...... 10 1.3. A brief history of yoga in Australia...... 11 1.4. The regulatory environment for yoga in Australia ...... 12 1.4.1. Professional associations...... 12 1.4.2. Teacher training standards...... 13 1.4.3. Nationally recognised training ...... 13 1.4.4. Yoga teaching insurance...... 14 1.4.5. Yoga therapy ...... 14 2. Review of the Literature ...... 15 2.1. Introduction ...... 15 2.2. Participation, practice and effectiveness ...... 15 2.3. Participation Studies ...... 16 2.3.1. Participation in yoga as physical activity or exercise ...... 16 2.3.1.1. Australian Bureau of Statistics. Participation in Sport and Physical Activities ...... 16 2.3.1.2. Australian Sports Commission. Participation in Exercise, Recreation and Sport (ERASS) in Australia ...... 19 2.3.1.3. YogaJournal.com - Yoga in America Survey 2003 and 2005 ...... 22 2.3.1.4. American Sports Data Inc. Superstudy by Sports Participation 2003 ...... 23 2.3.1.5. Sport England. Women’s Participation in Sport 2002 ...... 23 2.3.1.6. Australian Institute of Health and Welfare. Physical Activity Patterns of Australian Adults 2000 ...... 24 2.3.1.7. Behavioral Risk Factor Surveillance System. USA 2003 ...... 24 2.3.1.8. National Heart Foundation of Australia. Position paper on physical activity 2001...... 24 2.3.1.9. Nutrition Australia. Activities and activity levels for general health and well- being 1999 ...... 24 2.3.2. Participation in yoga as a form of therapy ...... 25 2.3.2.1. Complementary and Alternative Medicine Use in Australia in 2005: A National Population Based Survey...... 25 2.3.2.2. Integration of Complementary Therapies in Australian General Practice: Results of a National Survey ...... 25 2.3.2.3. The escalating cost and prevalence of alternative medicine (in Australia) 2000...... 26 2.3.2.4. Use of mind-body medical therapies (USA) 2004 ...... 26 2.3.2.5. Complementary and Alternative Medicine Use Among Adults: United States 2002.....27 2.3.2.6. Prevalence and Patterns of Adult Yoga use in the United States: results of a national survey ...... 28 2.3.2.7. World Health Organisation. Prevalence of use of complementary/alternative medicine: a systematic review 2000...... 28

2.4. Practice Studies...... 29 2.4.1. Medibank Private Australia. Sports Injuries Report 2004 ...... 29 2.4.2. Dru Yoga. Practitioner survey UK and Australia 2006...... 29 2.4.3. YogaJournal.com. What the Future Holds: Yoga 2030 Survey...... 30 2.4.4. British Wheel of Yoga. National Members Survey 2003 ...... 33 2.4.5. Manchester Yoga Survey 2000 ...... 34 2.4.6. YogaSite.com 1998 ...... 35 2.4.7. Other practice studies in progress at time of writing...... 35 2.5. Effectiveness studies...... 36 2.5.1. Introduction...... 36 2.5.2. The problem with CAM research ...... 38 2.5.3. Levels of evidence - measuring scientific rigour...... 39 2.5.4. Structure of this review...... 40 2.6. Cardiovascular health...... 42 2.6.1. Yoga lifestyle intervention...... 42 2.6.2. Summary of the evidence ...... 43 2.7. Mental health ...... 50 2.7.1. The concept of Adhi ...... 50 2.7.2. Summary of the evidence ...... 50 2.8. Musculoskeletal health...... 57 2.8.1. Summary of the evidence ...... 57 2.9. Womens’ health...... 60 2.9.1. Summary of the evidence ...... 60 2.10. Respiratory health...... 63 2.10.1. Summary of the evidence...... 63 2.11. Gastrointestinal health...... 66 2.11.1. Summary of the evidence...... 66 2.12. Cognitive function/neurological health ...... 67 2.12.1. Summary of the evidence...... 67 2.13. Cancer care...... 72 2.13.1. Summary of the evidence...... 72 2.14. Seniors and carers...... 75 2.14.1. Summary of the evidence...... 75 2.15. Competitve research funding ...... 76 2.16. Contraindications of yoga interventions ...... 77 2.17. National health priority areas ...... 78 2.17.1. Measuring years of life lost...... 78 2.17.2. Risk factors in Australia...... 79 2.18. Other influences on health, well-being and longevity ...... 80 2.18.1. Social capital...... 80 2.18.2. Religiosity, spirituality and meaning ...... 80 2.18.3. Calorie restriction ...... 82 2.18.4. Vegetarianism ...... 82 2.18.5. Perception, sleep...... 83 2.19. Handedness, nasal airflow and brain hemisphericity ...... 84

3. Methodology ...... 87 3.1. Rationale ...... 87 3.2. Research Questions...... 88 3.3. Justification for conducting a web-based survey...... 89 3.4. Potential for web-based survey bias...... 89 3.5. Advantages of conducting a web-based survey...... 90 3.6. Challenges in conducting a national web-based survey of yoga ...... 90 3.7. Design of the survey instrument ...... 91 3.8. Design of the website...... 93 3.9. Plain language statement and privacy policy...... 94 3.10. Ethics approval ...... 94 3.11. Recruitment...... 95 3.12. Potential for recruitment bias ...... 97 3.13. Registration for the survey ...... 97 3.14. Modular survey design ...... 97 3.15. Website statistics ...... 99 3.16. Data Collection and Analysis:...... 100 3.17. Yoga in Australia project timeline...... 101 4. Results ...... 104 4.1 Demographic and socio-economic characteristics of respondents ...... 104 4.1.1. Yoga teaching characteristics of respondents...... 104 4.1.2. Understanding the styles and style groups used in this report ...... 106 4.1.3. State of residence ...... 109 4.1.4. Understanding the Mean, Standard Deviation and N values...... 110 4.1.5. Age of participants ...... 112 4.1.6. Rurality ...... 116 4.1.7. Comparison of the demographic characteristics of respondents with the Australian population...... 117 4.1.8. Gender...... 119 4.1.9. Country of residence and nationality ...... 122 4.1.10. Handedness...... 123 4.1.11. Height, weight and Body Mass Index (BMI) ...... 125 4.1.12. Pregnancy ...... 127 4.1.13. Marital status ...... 128 4.1.14. Healthcare occupations...... 129 4.1.15. Involvement in yoga or meditation related research ...... 130 4.1.16. Supply of goods and services to the yoga community ...... 130 4.1.17. Religious or spiritual orientation...... 131 4.1.18. Level of education ...... 136 4.1.19. Employment status and industry...... 137 4.1.20. Household income...... 139 4.1.21. Participant comments ...... 141

4.2. Practice characteristics of respondents ...... 142 4.2.1. Session frequency ...... 142 4.2.2. Session length ...... 146 4.2.3. Reasons for beginning and continuing...... 150 4.2.4. Influences to begin practising...... 154 4.2.5. Years since first started practising ...... 156 4.2.6. Years of regular practice...... 159 4.2.7. Components of practice ...... 162 4.2.8. Other components and techniques of practice ...... 170 4.2.9. Meditation techniques...... 172 4.2.10. Supervision of practice...... 174 4.2.11. Places of practice ...... 175 4.2.12. Reasons for not practising...... 176 4.2.13. Money spent on practice ...... 177 4.2.14. Participant comments ...... 178 4.3. Health and lifestyle characteristics of respondents ...... 179 4.3.1. Dietary and lifestyle choices ...... 179 4.3.2. Sporting and physical activity ...... 181 4.3.3. Heath issues and medical conditions ...... 186 4.3.3.1. Introduction ...... 186 4.3.3.2. Health issues and medical conditions reported...... 188 4.3.3.3. Perceived effect of yoga practice on medical conditions...... 191 4.3.3.4. Medical conditions summary ...... 193 4.3.4. Perceptions of quality of life ...... 195 4.3.4.1. Introduction ...... 195 4.3.4.2. Perceived effect of yoga practice on quality of life ...... 195 4.3.5. Participant comments ...... 198 4.4. Yoga-related injuries...... 199 4.4.1. Introduction...... 199 4.4.2. Characteristics of participants who reported injuries ...... 200 4.4.3. Frequency of all postures reported...... 201 4.4.4. Other contributing factors reported...... 202 4.4.5. Parts of the body affected...... 203 4.4.6. Circumstances surrounding the injury ...... 205 4.4.7. Style of yoga practised at the time of the injury...... 207 4.4.8. Determining a yoga-related injury rate...... 209 4.4.9. Yoga and injury - a contradiction in terms?...... 211 4.4.10. Teacher adjustments and inappropriate teaching ...... 212 4.4.11. Participant comments ...... 213 4.5. Yoga and Flow ...... 214 4.5.1. Introduction to Flow...... 214 4.5.2. Characteristics of the sample responses to the flow scale ...... 216 4.5.3. Relative endorsement by yoga participants of the different flow dimensions ...... 217 4.5.4. Comparison of flow responses of yoga participants to a normative physical activity- performance sample...... 218 4.5.5. Summary of flow responses ...... 219

5. Discussion ...... 220 5.1. Introduction ...... 220 5.2. Strengths and weaknesses of this study...... 220 5.3. Other potential sources of bias ...... 220 5.4. Considerations in interpreting the data ...... 221 5.5. Meditation - an integral part of yoga ...... 221 5.6. Comparison between yoga teachers and their students...... 222 5.7. Characteristics of yoga practice in Australia...... 223 5.7.1. Unclear participation rate for yoga...... 223 5.7.2. Trend towards younger participation...... 223 5.7.3. Proportion of women to men in yoga ...... 224 5.7.4. Health benefits of yoga practice ...... 224 5.7.5. Components of yoga practice ...... 225 5.8. Yoga, spirituality, and meaning ...... 226 5.9. Therapeutic use of yoga ...... 228 5.10. Yoga for cardiovascular disease...... 229 5.11. Mental health and musculoskeletal health ...... 231 5.12. Left-handedness and yoga ...... 232 5.13. Yoga-related injuries...... 233 5.14. Participant comments ...... 235 6. Conclusion...... 236 7. References ...... 237 8. Appendices...... 249

List of Tables and Figures

Table 1.2.1. A brief history of yoga in Australia ...... 11 Table 2.3.1. Participation in Sport and Physical Recreation/Activities in Australia. Most popular activities by year ...... 17 Table 2.3.2. Participation in Sport and Physical Recreation/Activities in Australia. Summary of key findings in relation to yoga ...... 18 Table 2.3.3. Participation in Exercise, Recreation and Sport (ERASS) in Australia. Most popular activities by year ...... 19 Table 2.3.4. Participation in Exercise, Recreation and Sport (ERASS) in Australia. Summary of key findings as they relate to yoga by year ...... 21 Table 2.3.5. YogaJournal.com - Yoga in America 2003 and 2005...... 22 Table 2.3.6. Complementary and Alternative Medicine Use Among Adults: United States 2002 ...... 27 Table 2.4.1. Dru Yoga Practitioner survey UK and Australia 2006 ...... 30 Table 2.4.2. What the Future Holds: Yoga 2030 Survey ...... 31 Table 2.4.3. YogaJournal.com. What the Future Holds: Yoga 2030 Survey...... 32 Table 2.4.4. British Wheel of Yoga. National Members Survey 2003...... 33 Table 2.4.5. Manchester Yoga Survey 2000...... 34 Table 2.4.6. YogaSite.com 1998...... 35 Table 2.5.1. Pubmed keyword search, January 2008...... 37 Table 2.5.2. Oxford Centre for Evidence Based Medicine. Levels of evidence...... 39 Table 2.5.3. National Asthma Council Australia. Effectiveness scale ...... 39 Table 2.6.1. Yoga and meditation for Cardiovascular Disease, Hypertension, Dislipidemia, Metabolic (Insulin Resistance) Syndrome, Diabetes and weight management ...... 44 Table 2.7.1. Yoga and meditation for stress, anxiety, anxiety disorders mood disorders, sleep disorders and depression...... 52 Table 2.8.1. Yoga and meditation for chronic pain, back pain, Arthritis and Osteoarthritis ...... 58 Table 2.9.1. Yoga and meditation for womens health: pregnancy, symptoms of Menopause, and Pre-Menstrual syndrome...... 61 Table 2.10.1. Yoga and meditation for respiratory conditions including Asthma, Bronchitis and COPD...... 64 Table 2.11.1. Yoga and meditation for gastrointestinal symptoms, Irritable Bowel Syndrome (IBS), and Pancreatitis ...... 66 Table 2.12.1. Yoga and meditation for pain management, headaches and migraine, motor skills, cognitive function, Carpal Tunnel Syndrome, Multiple Sclerosis, and ADHD...... 68 Table 2.13.1. Yoga and meditation for cancer ...... 73 Table 2.14.1. Yoga and meditation for palliative care, carer health, dementia, and quality of life in geriatric care...... 75 Figure 3.8.1. Home page of website designed to host the survey...... 93 Figure 3.8.2. Registration/login page of survey...... 94 Table 3.11.1. Business listings for yoga in the online national White & Yellow Pages...... 95 Figure 3.11.2. Front and back of the invitation postcard...... 96 Table 3.14.1. Numbers of participants who completed each module...... 98 Table 3.15.1. Website statistics during the actual survey period...... 99 Table 3.17.1. Yoga in Australia project timeline ...... 101 Figure 4.1.1. Screenshot of the first page of the demographic module of the questionnaire...... 105 Table 4.1.2. Summary of the self-reported yoga teaching characteristics of 1265 respondents...... 105 Table 4.1.3. Styles by style group ...... 106 Table 4.1.4. Participants by style group ...... 107 Table 4.1.5. Participants by schools and styles of yoga and meditation...... 108 Table 4.1.6. State of residence by participant group ...... 109 Figure 4.1.7. Age of participants by participant group ...... 111 Table 4.1.8. Participants by age group and participant group...... 112 Table 4.1.9. Mean age of all participants by style group and gender...... 113 Table 4.1.10. Mean age of students by selected styles and gender...... 114 Table 4.1.11. Mean age of teachers by selected styles and gender...... 115 Table 4.1.12. Rurality by participant group...... 116

Table 4.1.13. Comparison of demographic characteristics of yoga survey respondents with the Australian population (from ABS Census data)...... 118 Table 4.1.14. Gender by participant group ...... 119 Table 4.1.15. Gender by participant group and style group...... 120 Table 4.1.16. Gender by participant group and selected styles...... 121 Table 4.1.17. Selected nationalities by participant group ...... 122 Table 4.1.18. Handedness by gender...... 123 Table 4.1.19. Summary of handedness by style group and gender ...... 123 Table 4.1.20. Handedness by selected styles and gender ...... 124 Table 4.1.21. Mean BMI by style group and gender ...... 125 Table 4.1.22. Mean BMI by selected styles and gender ...... 126 Table 4.1.23. Rate of pregnancy by participant group and style group...... 127 Table 4.1.24. Marital status by participant group ...... 128 Table 4.1.25. Healthcare occupations by participant group ...... 129 Table 4.1.26. Involvement in yoga or meditation related research by participant group ...... 130 Table 4.1.27. Supply of goods and services to the yoga community by participant group ...... 130 Table 4.1.28. Religious or spiritual orientation by participant group...... 131 Table 4.1.29. Religious or spiritual orientation of students by grouped years of regular practice ..... 132 Table 4.1.30. Religious or spiritual orientation of teachers by grouped years of regular practice...... 133 Figure 4.1.31. Religious or spiritual orientation of students by grouped years of regular practice .... 134 Figure 4.1.32. Religious or spiritual orientation of teachers by grouped years of regular practice .... 135 Table 4.1.33. Level of education by participant group ...... 136 Table 4.1.34. Employment status by participant group ...... 137 Table 4.1.35. Employment industry by participant group ...... 138 Table 4.1.36. Total gross household income by participant group...... 139 Figure 4.1.37. Total gross household income by participant group ...... 139 Table 4.1.38. Mean number of wage earners in household by participant group ...... 140 Table 4.1.39. Participant comments to the demographic module...... 141 Table 4.2.1. Session frequency by participant group ...... 142 Figure 4.2.2. Session frequency by participant group ...... 143 Table 4.2.3. Session frequency by participant group and style group...... 144 Table 4.2.4. Session frequency by participant group and selected styles ...... 145 Table 4.2.5. Session length by participant group...... 146 Figure 4.2.6. Session length by participant group ...... 147 Table 4.2.7. Session length by participant group and style group ...... 148 Table 4.2.8. Session length by participant group and selected styles ...... 149 Figure 4.2.9. Screenshot of the reasons for beginning and continuing question ...... 150 Table 4.2.10. Reasons for beginning and continuing by participant group ...... 151 Figure 4.2.11. Reasons for beginning and continuing: Students ...... 153 Figure 4.2.12. Reasons for beginning and continuing: Teachers...... 153 Table 4.2.13. Influences to begin practising ...... 154 Figure 4.2.14. Influences to begin practising ...... 154 Figure 4.2.15. Years since starting: Students...... 156 Figure 4.2.16. Years since starting: Teachers ...... 156 Figure 4.2.17. Years since starting by participant group ...... 157 Table 4.2.18. Years since starting (grouped) by participant group...... 158 Figure 4.2.19. Years since starting (grouped) by participant group...... 158 Figure 4.2.20. Years of regular practice: Students ...... 159 Figure 4.2.21. Years of regular practice: Teachers ...... 159 Figure 4.2.22. Years of regular practice by participant group ...... 160 Table 4.2.23. Years of regular practice (grouped) by participant group...... 161 Figure 4.2.24. Years of regular practice (grouped) by participant group...... 161 Table 4.2.25. Components of practice by participant group ...... 163 Table 4.2.26. Components of practice by style group: Students ...... 164 Table 4.2.27. Components of practice by style group: Teachers...... 165 Table 4.2.28. Components of practice by selected styles: Students ...... 166 Table 4.2.29. Components of practice by selected styles: Teachers ...... 167 Figure 4.2.30. Components of practice: Students (n=2357)...... 168

Figure 4.2.31. Components of practice: Teachers (n=1194) ...... 168 Figure 4.2.32. Components of practice: Students (n=2357)...... 169 Figure 4.2.33. Components of practice: Teachers (n=1194) ...... 169 Table 4.2.34. Other components and techniques of practice by participant group...... 170 Figure 4.2.35. Other components and techniques of practice by participant group...... 170 Table 4.2.36. Meditation techniques by participant group ...... 172 Figure 4.2.37. Meditation techniques by participant group...... 172 Table 4.2.38. Supervision of practice by participant group...... 174 Figure 4.2.39. Supervision of practice by participant group...... 174 Table 4.2.40. Places of practice by participant group ...... 175 Figure 4.2.41. Places of practice by participant group ...... 175 Table 4.2.42. Reasons for not practising by participant group...... 176 Figure 4.2.43. Reasons for not practising by participant group...... 176 Table 4.2.44. Money spent on practice per month by participant group ...... 177 Figure 4.2.45. Money spent on practice per month by participant group ...... 177 Table 4.2.46.Selected Participant comments to the practice module...... 178 Table 4.3.1. Dietary and lifestyle choices by participant group ...... 179 Figure 4.3.2. Dietary and lifestyle choices: Students ...... 180 Figure 4.3.3. Dietary and lifestyle choices: Teachers ...... 180 Table 4.3.4. Any sporting and physical activity in the previous 12 months by participant group compared to ERASS...... 181 Figure 4.3.5 Any sporting and physical activity in the previous 12 months by participant group ...... 182 Table 4.3.6. Sporting and physical activities by participant group ...... 183 Figure 4.3.7. Frequency of practice in the most popular sporting and physical activities: Students .. 185 Figure 4.3.8. Frequency of practice in the most popular sporting and physical activities: Teachers.. 185 Figure 4.3.9. Screenshot of the health issues and medical conditions question ...... 187 Table 4.3.10. Conditions reported by all respondents in each category ...... 188 Figure 4.3.11. Perceived effect of yoga practice on medical conditions: Students (N=1862) ...... 191 Figure 4.3.12. Perceived effect of yoga practice on medical conditions: Teachers (N=959)...... 191 Table 4.3.13. Perceived effect of yoga practice on medical conditions by participant group ...... 192 Table 4.3.14. All conditions reported to have got worse from yoga practice ...... 194 Figure 4.3.15. Perceptions of quality of life: Students (N=2389) ...... 196 Figure 4.3.16. Perceptions of quality of life: Teachers (N=1162) ...... 196 Table 4.3.17. Perceptions of quality of life by participant group ...... 197 Table 4.3.18. Participant comments to the health module ...... 198 Figure 4.4.1. Injury report form ...... 199 Table 4.4.2. Characteristics of participants who reported injuries by participant group ...... 200 Table 4.4.3. Frequency of all postures reported...... 201 Figure 4.4.4. Frequency of all postures reported...... 202 Table 4.4.5. Parts of the body affected by participant group...... 203 Figure 4.4.6. Parts of the body affected by participant group...... 204 Table 4.4.7. Circumstances surrounding the injury by participant group...... 205 Figure 4.4.8. Circumstances surrounding the injury by participant group ...... 206 Table 4.4.9. Styles by style group ...... 207 Table 4.4.10. Proportion of injury reports by proportion of survey respondents by style group and participant group...... 207 Figure 4.4.11. Proportion of injury reports by proportion of survey respondents by style group and participant group...... 208 Table 4.4.12. Injuries reported by circumstances and participant group...... 210 Table 4.4.13. Selection of participant comments...... 213 Figure 4.5.1. Relative endorsement by yoga participants of the different flow dimensions ...... 217 Figure 4.5.2. Comparison of flow responses of yoga participants to a normative physical activity- performance sample...... 218 Table 5.1.1. Selection of participant comments...... 235

Abbreviations

AAYIDL Australian Association of Yoga in Daily Life AAYT Australian Association of Yoga Therapists ABS Australian Bureau of Statistics ADHD Attention Deficit Hyperactivity Disorder AFYT Australian Fellowship of Yoga Teachers AIHW Australian Institute of Health and Welfare ASC Australian Sports Commission ASD American Sports Data AYTN Australian Yoga Teachers Network BKSIYAA BKS Iyengar Yoga Association of Australia BMI Body Mass Index BRFSS Behavioural and Risk Factor Survey System BWY British Wheel of Yoga CAM Complementary and Alternative Medicine CBT Cognitive-based Therapy CC Corpus Callosum CEBM Centre for Evidence-based Medicine CHF Congestive Heart Failure COPD Chronic Obstructive Pulmonary Disease CVD Cardio-vascular Disease DALY Disability Adjusted Life Years ECT Electro-convulsive Therapy EEG Electroencephalogram ERASS Exercise Recreation and Sport Survey FinY Friends in Yoga GHS General Household Survey GI Glycaemic Index GPs General Practitioners HDL High Density Lipoprotein IAYT International Association of Yoga Therapists IBS Irritable Bowel Syndrome IRS Insulin Resistance Syndrome IYTA International Yoga Teachers Association KHYF Krishnamacharya Healing Yoga Foundation LDL Low Density Lipoprotein MBSR Mindfulness-Based Stress Reduction MI Myocardial Infarction MRI Magnetic Resonance Imaging NCBI National Centre for Biotechnology Information NCCAM National Centre for Complementary and Alternative Medicine NIDDM Non-Insulin Dependent Diabetes Mellitus NIH National Institutes of Health OECD Organisation for Economic Co-operation and Development PMR Progressive Muscle Relaxation

RCT Randomised Controlled Trial RMIT Royal Melbourne Institute of Technology University RRMA Rural, Remote and Metropolitan Area RTO Registered Training Organisation RYT200® Registered Yoga Teacher 200 hours training RYT500® Registered Yoga Teacher 500 hours training SCORS Standing Committee on Recreation and Sports SKY Surdarshan Kriya Yoga SYTA Satyananda Yoga Teachers Association TM Transcendental Meditation WHO World Health Organisation YLD Years Lost to Disability YLL Years of Life Lost YTAA Yoga Teachers Association of Australia YTISA Yoga Teachers Institute of South Australia

Executive Summary

Yoga is an ancient Indian philosophy of living that includes physical postures, breathing techniques, meditation, relaxation, moral codes and other practices. Together, it is said that these practices and philosophy provide a path to self-realisation, or union between the individual and the universal consciousness.

Aspects of yoga are widely practised in Australia and around the world, often as a physical activity for health and well-being. However, there are many unanswered questions regarding the practice of yoga in Australia, such as the characteristics of people who practice yoga, the styles, traditions and techniques practised, the frequencies and characteristics of practice, the reasons for practice, the associated dietary and lifestyle choices, the perceived benefits of practice, and the frequency and characteristics of yoga-related injuries.

In order to answer these questions, a national web-based survey of yoga in Australia was conducted in 2006. Yoga teachers and their students were recruited through yoga studios, teacher associations, the media and word of mouth, resulting in nearly 4000 respondents nationally. The results for yoga teachers and their students (practitioners) were reported separately.

The typical yoga survey practitioner was found to be a 41 year old, tertiary educated, employed, health-conscious woman. Overall, 85% of survey participants were women. Men, and the younger age groups, were attracted to the stronger, dynamic styles of yoga.

Asana and Vinyasa (postures and sequences of postures) were found to represent 61% of time spent practising yoga, however about one third of time spent practising (30%) was devoted to the gentler, more spiritual practices of relaxation, pranayama (breathing techniques) and meditation, suggesting yoga in Australia is a healthy mix of the practices in yoga.

Survey participants commonly started practising yoga for physical reasons or stress management, but some found a spiritual dimension in yoga once practising. Yoga may provide a source of greater meaning, especially for people who do not identify with traditional western religions, and may impact further on religious orientation with years of practice.

Regular yoga practice may also have a protective effect on health and longevity due to associated lifestyle choices including healthy eating, vegetarianism, reduced smoking, reduced alcohol consumption, increased spirituality (religiosity), reduced stress, and other mental and physical health benefits.

One in five respondents reported using yoga for a specific health issue or medical reason. Medical conditions and perceptions of quality of life were seen to be greatly improved by yoga practice. More people used yoga to address mental health issues (e.g. stress, anxiety, depression) than physical problems (e.g. back pain), suggesting that mental health may be the primary health reason for practising yoga.

However, in the absence of any formal system of co-ordination or referral between the medical and yoga teaching professions, it seems that people are self-prescribing yoga for their health concerns. Better integration in this area would likely have additional health benefits for the community, representing an opportunity for the yoga teaching community to partner with cardiology, mental health services, and general practice in the design and delivery of suitable programs.

The incidence of yoga-related injuries was low, suggesting yoga is a relatively safe practice compared to other physical disciplines. However, further research is required to better understand the practices and contributing factors associated with injuries.

Further research is required to better understand the effect of yoga practice on religious and spiritual orientation, dietary and lifestyle choices, yoga-related injuries, and to quantify the cost benefits of yoga practice to the Australian healthcare system and community.

1. Introduction

1.1. A brief introduction to yoga

This introduction is intended as an overview to provide context for this report, and to assist readers who do not have an understanding of yoga.

The term 'yoga' is derived from the Sanskrit term 'yuj' meaning ‘to join’, or 'that which joins'. In the traditional terminology it is the joining of Jivatma, the individual self or consciousness, with Paramatma, the universal consciousness.

Yoga has its modern roots in the ancient Indian scriptures known as the Vedas, dating back about 5000 years. Prior to that, yoga was an oral tradition pre-dating our current knowledge, its origins unknown. Yogic texts elaborate upon the nature of reality, existence and human experience. These texts include the 18 Upanisads, which give interpretation to and expand on the meaning of the four main Vedas (scriptures), Patanjali's Yoga Sutras, the Bhagavad Gita (Arjuna’s battlefield conversation with Lord Krishna), the Hatha Yoga Pradipika, the Gheranda Samhita, the Shiva Samhita and more recently, the Yoga Vasistha (Vasista’s teachings on yoga to Sri Rama).

Patanjali, thought to have lived between 820 BCE and 300 BCE, was the first of the great sages to condense the yogic teachings into 196 aphorisms called the Yoga Sutras. In his second aphorism, Patanjali said “Yogah Citta Vrtti Nirodhah,” or yoga is a process of ceasing the disruptions of the mind1. Meaning that by stilling the mind we can reach our natural state.

Patanjali’s Yoga Sutras describe the Raja (royal/king) yoga philosophy. Raja yoga, often described as the path of meditation or control of the mind, describes eight ‘limbs’ (Astanga) in the journey towards enlightenment2:

Yama (ethical behaviour restraints) Niyama (personal observances) Asana (postures - traditionally meaning ‘seated’ postures) Pranayama (breathing techniques to exercise the lifeforce or prana) Pratyahara (withdrawal from the senses) Dharana (focusing or concentration meditation) Dhyana (defocusing, mindfulness or still mind meditation) Samadhi (self-realisation or perfect non-separateness)

The Bhagavad Gita is probably the central and most influential yogic scripture and describes various practices that allow aspects of the individual to be cultivated. It is thought to have been written about 150 BCE by an unnamed Krishna devotee, however the date of authorship is unclear.

The Hatha Yoga Pradipika, written by Swami Swatmarama in the 15th century CE, takes a more physical approach. Ha (Sun) tha (moon) yoga is about bringing balance between opposing forces and energy systems within the body through the use of asana (postures), pranayama (breathing techniques), mudra (subtle gestures directing energy) and bandha

1 Nagarathna, R, Nagendra, HR. Integrated Approach of Yoga Therapy for Positive Health. Swami Vivekananda Yoga Prakashana, 2001. 2 Iyengar BKS. Light on Yoga. Harper Collins Publishers 2001, (pp1-31).

1. Introduction

(muscular and energetic locks)3. Hatha yoga also deals with chakras (energy centres), kundalini (movement of energy up the spine), kriyas (cleansing techniques), shakti (sacred energy), and nadis (energy flow within the body).

‘Hatha’ and ‘Raja’ are the two main philosophical branches of yoga, however their roots and practices are intertwined. Other well known philosophical branches of yoga include Karma yoga (the path of action/service), Bhakti yoga (the path of devotion/worship), and Jnana yoga (the path of philosophical/intellectual enquiry).

Other branches of yoga include Mantra, Laya, Tantra, Yantra, Kundalini, Kriya, Guru and Anna yoga. Each branch of yoga offers a philosophy by which we can come to understand who we are and what our purpose is.

Swami Vivekananda (1863-1902), a disciple of Rama Krishna (1836 -1886), is often credited as first introducing the Vedic philosophy to the west by his address representing Hinduism to the World Parliament of Religions in Chicago in 1893. However, a century earlier, British orientalists and German scholars were engaged in scholarly exchange on aspects of Vedic literature.

Yoga gained further popularity in the west in the 1950s and 60s along with rising interest in, and cultural acceptance of, alternative and mind-body-soul practices. Today, yoga is widespread, often practised as an exercise form utilising the postures, or as a therapy using specific yoga techniques for health benefits. Very often it is for these reasons that people first come to experience yoga. However, some people develop a deeper understanding and practice of yoga as a holistic lifestyle and a spiritual path towards self-realisation.

3 Swami Satyananda Saraswati. Asana Pranayama Mudra Bandha. Yoga Publications Trust, Munger, Bihar, India. 2004.

1. Introduction

1.2. Defining yoga

Yoga in Australia is often misunderstood or oversimplified to be referred to as Hatha yoga.

Well known styles of yoga such as Iyengar (focus on correct postural alignment), Ashtanga (dynamic/flowing sequences), Satyananda (an integrated form of contemporary classical yoga), Bikram (a sequence of postures in a heated room), Kundalini (movement of energy in the body) are all modern interpretations (styles) of Hatha yoga philosophy, often blended with Raja yoga and other yogic philosophies.

To make it more confusing, teachers develop their own personal style based on their own exposure to, and understanding of, the yogic practices and philosophies, so there are probably as many ‘styles’ of yoga as there are yoga teachers, or practitioners.

By way of example, to explain the integration of philosophies and practices within styles of yoga, Satyananda yoga is an integrated tantric style of yoga that encompasses lifestyle, asana (postures), meditation, pranayama (breathing techniques), mudra (subtle gestures directing energy), bandha (muscular locks directing energy), kriyas (cleansing techniques), seva (service) and Raja, Kundalini and Karma yoga philosophy. Philosophically, Satyananda yoga may be more closely aligned with Raja Yoga than Hatha yoga, since the asana and pranayama practices are geared towards introspection for meditation rather than extroversion as a physical practice.

The term ‘yoga’, by usage over many centuries may refer to any and all of these practices and philosophies, in whole and in part. Therefore, it is inappropriate to attempt to create a narrower definition in an attempt to acheve methodological rigour in this report. By doing so would be to unnaturally limit the report to something ‘less than’ yoga and therefore fail to properly describe yoga in Australia.

However, in proceeding without a clear definition of yoga other than common and historical usage of the term, the reader is advised that when the term ‘yoga’ is used in this report, it may refer to the philosophies and practices of yoga as a whole, or by context, may refer to specific philosophies or practices or an integration thereof. This is especially evident in the review of the scientific and medical literature later in this report, where medical interventions incorporating a wide range of yoga practices are all referred to as ‘yoga’ despite the practices being different, but must be included in order to create a context for the later results and discussion of the reported health benefits of yoga survey participants.

In the same way, the term ‘meditation’ and other yoga related terms can be taken to have the meanings ascribed to them by common and historical usage. It is important to note that meditation is an integral part of yogic philosophy. Some meditative styles of yoga do not involve any physical practices such as postures, while other physical styles of yoga may not involve any meditation. In this report, where the term yoga is used, it can usually be taken to include the meditative practices within yoga except where the context indicates otherwise.

1. Introduction

1.3. A brief history of yoga in Australia

Table 1.2.1 provides a condensed timeline of yoga in Australia. It is intended as an overview, not a definitive account, in order to illustrate the common belief that yoga first gained popularity in Australia through the efforts of Michael Volin, Margrit Segesman and Roma Blair in the 1950s.

Table 1.2.1. A brief history of yoga in Australia

Year Person Event 1950 Michael Volin Established the Sydney Yoga Centre (1914-1998) 1954 Margrit Segesman Established Gita Yoga Melbourne (1904-1998) 1956 Roma Blair Established the Sydney Yoga Club 1964 Shri Vijayadev Established the Yoga Education Centre in Melbourne Yogendra 1966 Swami Satchitananda Established Integral Yoga in Australia (1914-2002) Swami Sarasvati Began teaching in Sydney 1967 International Yoga Teachers Association was formed Maharishi Mahesh Visited Australia and Maharishi group formed Yogi (~1918-2008) 1969 Acharya Upendra Roy Established Yoga Meditation Centre in Melbourne (1942-2006) 1974 BKS Iyengar Iyengar Yoga Institute established in Pune, India Satyananda ashram established outside Sydney Baba Muktananda Established Siddha yoga in Australia (1908-1982) 1984 Iyengar yoga established in Australia 1984-2002 Various other styles of yoga established in Australia including Vini Yoga (TVK Desikachar) and Ashtanga Yoga (Pattabhi Jois) Source: Courtesy Gita International Yoga.

1. Introduction

1.4. The regulatory environment for yoga in Australia

There is no government regulation of yoga in Australia. Any person can teach yoga and advertise their services as a yoga teacher. The Yoga Teachers Association of Australia estimates that there are about 5000 active yoga teachers in Australia4.

Yoga is perceived as a relatively safe and beneficial practice and as such, there is currently no suggestion that State or Federal government has considered the regulation of yoga teaching.

1.4.1. Professional associations The yoga teaching profession is loosely self-governed by a number of teacher associations and tradition-based teacher groups, each with its own requirements for membership. They include:

Yoga Teachers Association of Australia (YTAA) With over 1000 members, YTAA is the largest teacher association in Australia accepting members from any tradition or style of yoga, subject to meeting minimum training and experience requirements. Associate membership is open to other interested parties.

International Yoga Teachers Association (IYTA)5 The IYTA is the oldest teacher association in Australia, formed in 1967. It has a membership base of around 600 teachers who have completed the IYTA Teacher Training Course, both in Australia and overseas. Associate membership is open to other interested parties.

Satyananda Yoga Teachers Association (SYTA)6 Full membership of SYTA is open to yoga teachers who have trained in the Satyananda tradition (about 300); or are currently undertaking Satyananda yoga teacher training. Associate membership is open to others who support SYTA's aims.

BKS Iyengar Yoga Association of Australia (BKSIYAA)7 BKSIYAA membership consists of approximately 500 general members and 200 certified Iyengar yoga teachers in Australia. Certified teachers are rigorously assessed and categorised by levels of training.

Yoga Alliance8 Yoga Alliance is a US based organisation accepting members from anywhere in the world who have completed 200 or 500 hours of suitable teacher training. About 110 yoga teachers appear on the Yoga Alliance website under ‘find a teacher search’ for Australia, compared to over 17,000 for USA, but there may be more Australian members of Yoga Alliance who do not appear in the search facility.

4 Yoga Teachers Association of Australia. http://www.yogateachers.asn.au/. Accessed 8/1/08. 5 International Yoga Teachers Association of Australia. http://www.iyta.org.au/. Accessed 8/1/08. 6 Satyanananda Yoga Teachers Association. http://www.syta.org.au/ Accessed 8/1/08. 7 BKS Iyengar Yoga Association of Australia. http://www.iyengaryoga.asn.au/. Accessed 8/1/08. 8 Yoga Alliance. http://www.yogaalliance.com/. Accessed 8/1/08.

1. Introduction

Other teacher associations and groups include:

Gita International Yoga Teachers Guild9 Australian Association of Yoga in Daily Life (AAYIDL)10 Shanti Yoga Teachers Association11 Dru Yoga Teachers Association12 Australian Yoga Teachers Network (AYTN)13 Yoga Teachers Institute of South Australia (YTISA)14 Friends in Yoga (FinY) West Australia15 Australian Fellowship of Yoga Teachers (AFYT)16 Krishnamacharya Healing Yoga Foundation (KHYF)17

The regulatory environment for yoga in other countries, such as the UK and USA, is similar to Australia, in that there is no government regulation and the profession is loosely governed by a number of teacher associations.

1.4.2. Teacher training standards Most of the teacher associations mentioned above provide yoga teacher training in their particular style or tradition of yoga, with the exception of YTAA, BKSIYAA, Yoga Alliance and YTISA, which act as registration bodies, and AFYT, which acts as a forum for fellowship and shared learning. Many other commercial yoga teacher training courses are available throughout Australia, ranging from a few weeks full-time to a number of years part-time, with some offering post-graduate support networks similar to the teacher associations mentioned.

As an example of the number of hours training required to become a yoga teacher, YTAA has a minimum requirement of 350 hours over 12 months for Full membership, and a ‘Provisional’ level of membership after 200 hours training. BKSIYAA and SYTA require more training of their Iyengar and Satyananda teachers respectively, up to about 1000 hours. Yoga Alliance however, operates the RYT200® and RYT500® ‘Registered Yoga Teacher’ registration system around the world with no minimum duration of training, recognising teachers with 200 or 500 hours of training in the appropriate curriculum areas.

1.4.3. Nationally recognised training Yoga is currently not included in the scope of the SRF04 Fitness Industry Training Package18 (2004), nor is it included in the Health Training Package HLT0719 (2007), which includes modalities like Ayurveda, Homoeopathy, Naturopathy, Herbal Medicine and Massage in a grouping called ‘Complementary and Alternative Health Care’. The Health Training Package HLT02 Review project20, which commenced in 2002 and concluded in 2007, did not result in

9 Gita International Yoga. http://www.gita.com.au/. Accessed 8/1/08. 10 Australian Association of Yoga in Daily Life. http://www.yogaindailylife.org.au/. Accessed 8/1/08. 11 Shanti Yoga. http://www.shantiyoga.com.au/. Accessed 8/1/08. 12 Life Foundation School of Therapeutics (Aust). http://www.dru.com.au/. Accessed 8/1/08. 13 Australian Yoga Teachers Network. http://www.aytn.com.au/. Accessed 8/1/08. 14 Yoga Teachers Institute of South Australia. http://www.ytisa.net/. Accessed 8/1/08. 15 Friends in Yoga. http://www.friendsinyoga.org.au/. Accessed 8/1/08. 16 Australian Fellowship of Yoga Teachers. http://www.afyt.info. (proposed website) 17 Krishnamacharya Healing Yoga Foundation. http://khyf.net/. Accessed 8/1/08. 18 National Training Information Service. http://www.ntis.gov.au/Default.aspx?/trainingpackage/SRF04. Accessed 8/1/08. 19 Industry Skills Council. Health Training Package HLT07. http://www.cshisc.com.au/load_page.asp?ID=234. Accessed 8/1/08. 20 Industry Skills Council. Health Training Package Review project HLT02. http://www.cshisc.com.au/load_page.asp?ID=56. Accessed 8/1/08.

1. Introduction

the inclusion of yoga. However, yoga therapy (see below) is a more likely candidate for inclusion in a future Health Training Package.

Despite falling outside any of the National Training Packages, there are a small number of yoga teacher training courses that have applied for, and received recognition as a Registered Training Organisation (RTO) in order to provide nationally recognised yoga teacher training.

Two such courses are the Diploma of Satyananda Yoga Teaching, delivered by the Satyananda Yoga Academy21 and the Advanced Diploma of Yoga Teaching, delivered for the Council of Adult Education in Melbourne22 by the Australian Institute of Yoga23. Another course delivered by Greenwood Yoga Centre in Perth24 is structured as a Certificate III in Fitness under the Fitness Training Package, but ‘contextualised for yoga’ in order to issue graduates with both a Certificate III in Fitness and a Diploma in Yoga Teaching.

1.4.4. Yoga teaching insurance As with other unregulated healthcare modalities, insurance companies generally require yoga teachers to demonstrate and maintain membership of a professional association as a condition of insurance, or otherwise to demonstrate a reasonable level of training prior to being granted insurance.

In Australia, insurance companies generally see yoga as a therapeutic modality. Therefore, only a small number of specialist health insurers offer insurance to yoga teachers. OAMPS and AON are the two largest insurers of yoga teachers, offering cover under their complementary therapy and paramedical policies respectively. However, in the fitness industry, registered fitness instructors who teach yoga, or yoga-like classes, receive cover under the terms of their insurance policy with Fitness Australia’s insurer.

1.4.5. Yoga therapy Yoga therapy, an ancient practice in India and an integral part of many traditions in yoga, has only in recent decades become established as a recognised therapeutic modality internationally through the auspices of the International Association of Yoga Therapists (IAYT)25.

Yoga therapy, as distinct from yoga teaching, is the application of the philosophy and practices of yoga in the setting of a yoga therapist/client relationship to achieve specific health and well-being outcomes. Therefore, it may be considered appropriate for inclusion in a future Health Training Package.

In Australia, yoga therapy became formally established in 2007 with the first nationally recognised training course, the Graduate Certificate in Yoga Therapy, delivered for the Council of Adult Education by the Australian Institute of Yoga26, together with the formation of the Australian Association of Yoga Therapists (AAYT)27, to develop standards.

21 Satyananda Yoga Academy. http://www.satyananda.net/Training/. Accessed 8/1/08. 22 Council of Adult Education. http://www.cae.edu.au/?infosection=yoga. Accessed 8/1/08. 23 Australian Institute of Yoga. http://www.australian-institute-yoga.com.au/teacher_training_and_courses/. Accessed 8/1/08. 24 Greenwood Yoga Centre. http://www.greenwood-yogacentre.com.au/. Accessed 8/1/08. 25 International Association of Yoga Therapists . http://www.iayt.org/. Accessed 8/1/08. 26 Australian Institute of Yoga. http://www.australian-institute-yoga.com.au/yoga_therapy_training/. Accessed 8/1/08. 27 Australian Association of Yoga Therapists. http://www.yogatherapy.org.au/. Accessed 8/1/08.

2. Review of the literature

2. Review of the Literature

2.1. Introduction

For the purposes of this review of the literature, it is important to understand that the term ‘yoga’ is used widely in the literature to describe many aspects of yoga of practice, ranging from philosophical approaches, meditative (non-physical) practices, to entirely physical practices. Further, in the medical literature, yoga practices are often blended with non-yoga techniques to form an intervention, but may still be referred to as a yoga intervention. In practical terms, the literature review aimed to locate studies referring to yoga, which would provide context or comparison to the yoga survey data. The search was not limited to an artificial definition of the term yoga, but took usage of the term to justify consideration.

Therefore, a detailed literature search was conducted to find studies relating to yoga in three domains: participation in yoga, the practice of yoga, and the effectiveness of yoga as an intervention, both in Australia and overseas. Research into participation in, and practice of, yoga was largely obtained using an extensive Google search, while research into the effectiveness of yoga was primarily obtained by searching Pubmed, an online medical and scientific research database. More details on search strategies follow in the respective sections of this review.

It is also useful to draw a distinction between the three domains described above.

2.2. Participation, practice and effectiveness

Participation (or prevalence), is a measure of the proportion of a population who practice yoga. Participation rates are most commonly expressed as the percentage of the population that practised yoga at least once in the previous 12 months. Participation data for yoga was most often found in national population studies relating to physical activity or complementary therapy use. No studies were found quantifying participation in yoga as a spiritual path or way of life.

Practice studies provide information about the who, what, where, when, why and how of yoga practice. For example, the demographics and socio-economic characteristics of people who practice yoga, reasons for practising (including lifestyle and spiritual reasons), styles and techniques practised, medical conditions being addressed by yoga practice, perceived benefits of practice, and the factors contributing to yoga-related injuries. At the time of writing, there were no national practice studies for yoga in Australia and very few overseas.

Effectiveness is a measure of the usefulness of yoga as a therapeutic intervention, encompassing yoga’s ability to treat the condition it is indicated for (efficacy), tolerability and ease of use28. For example, systematic reviews, randomised controlled trials (RCTs), and population-based studies investigating yoga-related interventions for specific health and well-being outcomes. A considerable and growing body of research into the effectiveness of yoga for the prevention, management and treatment of various medical conditions was found in the medical and scientific literature worldwide.

28 Medscape General Medicine, 2003;5(1). Side Effects and Therapeutic Effects: Efficacy Vs Effectiveness. http://www.medscape.com/viewarticle/448250_2. Accessed 15/2/08.

2. Review of the literature

2.3. Participation Studies

2.3.1. Participation in yoga as physical activity or exercise

2.3.1.1. Australian Bureau of Statistics. Participation in Sport and Physical Activities Every four years, the Australian Bureau of Statistics (ABS) publishes ‘Participation in Sport and Physical Activities’, a report using data collected in the Multi-Purpose Household Survey as a supplement to the Labour Force Survey. Yoga participation was reported in the 2002 and 2005-06 studies, but not in the earlier 1997-98 study.

In the 2002 study29, the ABS reported that 62.4% of the Australian population had participated in a sport or physical activity at least once in the previous 12 months while 38.6% participated at least weekly, with both men and women equally represented. The 18- 24 age group (72.6%) and the 25-34 age group (71.8%) were most likely to participate in any type of physical activity.

In 2002, 2.1% of the adult population (311,000 people) participated in yoga, making it marginally more popular than Australian Rules football with 307,900 people participating. It was the 14th most popular physical activity, and at that time 85.6% of yoga participants were women.

In the 2005-06 study30, the national sport and physical activities participation rate had increased to 65.9%, once again equally distributed between men and women. Of these, 42.7 % participated at least weekly (32% twice weekly or more) for at least part of the year and again the highest participation rates (about 75%) were seen in the younger age groups of 15-17 years and 25-34 years.

However in 2006, yoga participation had fallen to 1.7% (268,700 people and 90% women), but interestingly the proportion of people participating in Australian Rules football also fell equally. Participation in other physical activities also declined, leaving yoga as the 13th most popular activity, still just ahead of Australian Rules. As another comparison, participation in Pilates (not reported in the 2002 study) was at 0.8% of the population in 2005-06.

It is important to note that the ABS canvassed the 15-17 age group for the first time in the 2006 study, effectively adding 610,500 young people to the population surveyed, yet the 15- 17 age group is about as unlikely to practice yoga (0.3%) as the 65+ age group (0.3%), potentially adding to the apparent downward trend in yoga participation.

As for many of the studies discussed in this literature review, factors relating to the sampling and methods are unknown, therefore figures and any year-to-year comparisons need to be interpreted with caution.

29 Australian Bureau of Statistics. Participation in Sport and Physical Activities, Australia 2002. http://www.ausstats.abs.gov.au/ausstats/subscriber.nsf/0/6F5B6923AC4E41D0CA256DF600016E68/$File/41770_2002.pdf. Accessed 6/10/07. 30 Australian Bureau of Statistics. Participation in Sport and Physical Recreation, Australia 2005-6. http://www.ausstats.abs.gov.au/ausstats/subscriber.nsf/0/A36EC2C4EAD3937BCA257281001ADA51/$File/41770_2005-06.pdf. Accessed 6/10/07.

2. Review of the literature

Table 2.3.1 shows the rates of participation in physical activities in 2002 and 2006. Given that national participation increased from 62.4% to 65.9% over the four years between the two studies, this would suggest that the effect of adding the younger 15-17 age group to the surveyed population in 2005-06, may have led to a re-organisation of the participation rates of some sports and physical activities. In the same way, participation rates in some activities may arguably be affected by an increasingly ageing population and a growing migrant population in Australia. Another potential influence, presumably resulting in increased participation rates, may be the effect of major sporting events like the Olympic Games in Sydney in 2000 and the Commonwealth Games in Melbourne in 2006.

Table 2.3.1. Participation in Sport and Physical Recreation/Activities in Australia. Most popular activities by year

Sport/physical activity Participation rate 2002 2005-06 (18+ y.o.) (15+ y.o.) Walking 25.3% 24.7% Aerobics 10.9% 12.6% Swimming 10.9% 9.0% Golf 7.5% 5.5% Tennis 6.8% 4.8% Cycling 5.7% 6.3% Running 4.6% 4.3% Fishing 3.5% 1.6% Bushwalking 3.2% 3.2% Netball 3.1% 2.7% Soccer 2.6% 2.6% Basketball 2.4% 2.1% Cricket 2.5% 2.1% Yoga 2.1% 1.7% Australian Rules 2.1% 1.7% Source: This table presents composite figures from the Australian Bureau of Statistics reports referenced in this section.

Another change in the ABS methodology was to report frequency of weekly participation for ‘part of the year’ in 2006, rather than being averaged over the entire year. This in turn inflated the ‘at least weekly’ figure across most activities and explains the high at least weekly figures shown in Table 2.3.2 below. This means that in 2005-06, 75.5% of yoga participants practised yoga at least weekly for at least part of the year.

2. Review of the literature

Table 2.3.2. Participation in Sport and Physical Recreation/Activities in Australia. Summary of key findings in relation to yoga

Key findings in relation to yoga: 2002 2005-06 (18+ y.o.) (15+ y.o.) Population (000s) 14,513 16,008 Participants in sport/activity (000s) 9,056 10,549 National sport/activity participation rate 62.4% 65.9% Yoga participants 311,000 273,500 Australian Rules participants 307,900 268,700 Male yoga participation rate 0.6% 0.3%* Female yoga participation rate 3.6% 3.1% Total yoga participation rate 2.1% 1.7% Australian Rules participation rate 2.1% 1.7% Proportion of women to men in yoga 85.6% 90.0% Practised at least weekly 27.0%^ 75.5%# Organised practice only (e.g. class attendance) 56.9% 50.2% Non-organised only (e.g. home practice) 32.7% 44.9% Participation in yoga by age group: 15-24 1.9%* 1.5%* 25-34 2.9% 3.1% 35-44 2.5% 2.1% 45-54 2.5% 1.8% 55-64 1.7% 2.0% 65+ 0.8%* 0.3%* * relative standard error of between 25-50% - figure is unreliable ^ at least weekly over the whole year # at least weekly for at least part of the year Source: This table presents composite figures from the Australian Bureau of Statistics reports referenced in this section.

2. Review of the literature

2.3.1.2. Australian Sports Commission. Participation in Exercise, Recreation and Sport (ERASS) in Australia The Australian Sports Commission (ASC), through the State/Territory Departments of Sport and Recreation and the Standing Committee on Recreation and Sports (SCORS), have each year since 2001, published a report on Participation in Exercise, Recreation and Sport (ERASS) in Australia31. Like the ABS data, ERASS provides a useful understanding of year-to- year movements in yoga participation, however it is not possible to directly compare the ABS or ERASS figures, given that the sampling frames and methods are unknown, and any year- to-year comparisons must assume consistent methodology.

Table 2.3.3 below represents a summary of ERASS data over seven years as it relates to yoga, once again in the context of other physical activities and highlighting Australian Rules football by way of contrast.

Table 2.3.3. Participation in Exercise, Recreation and Sport (ERASS) in Australia. Most popular activities by year

Sport/physical activity 2001 2002 2003 2004 2005 2006 2007 Walking (not bushwalking) 28.8 30.8 37.9 39.0 37.3 36.2 33.0 Aerobics 13.0 14.6 16.0 17.1 18.5 19.1 20.2 Swimming 16.0 14.9 15.3 16.5 14.4 13.6 12.0 Cycling 9.5 9.3 9.4 10.5 10.3 10.1 9.7 Running 7.2 7.6 7.6 8.3 7.7 7.4 7.6 Tennis 9.2 8.2 9.0 8.4 7.8 6.8 5.8 Golf 8.2 8.7 8.2 7.9 7.1 6.8 5.6 Bush walking 5.3 5.6 5.8 5.2 5.7 4.7 5.7 Soccer (outdoor) 3.7 4.5 4.3 4.2 3.8 4.2 4.2 Netball 4.1 4.1 3.9 3.6 3.6 3.6 3.2 Basketball 3.5 4.0 3.6 3.2 3.5 3.3 3.0 Cricket (outdoor) 2.7 3.0 3.3 3.1 2.9 3.2 2.5 Weight training 2.9 2.2 2.8 2.7 2.0 3.1 2.1 Yoga 1.5 3.0 3.1 3.4 3.4 2.9 2.8 Australian Rules 2.3 2.5 2.8 2.9 3.4 2.7 1.9 Touch football 2.7 2.4 2.3 2.3 2.3 2.4 2.3 Dancing 2.0 2.1 2.2 2.4 2.2 2.4 1.8 Surf sports 2.4 2.2 2.4 3.2 2.6 2.3 1.9 Fishing 2.4 2.3 2.6 2.3 2.1 2.1 1.6 Lawn bowls 1.9 2.3 2.3 2.3 2.2 2.1 2.1 Martial Arts 2.1 2.1 2.3 2.0 2.0 1.8 1.9 Squash 2.2 2.3 2.2 1.9 1.5 1.3 1.2 All figures show % of the population Source: This table presents composite figures from the Australian Sports Commission year by year ERASS reports referenced in this section.

31 Australian Sports Commission, the SCORS Research Group (SRG). Participation in Exercise, Recreation and Sport (ERASS) in Australia. http://www.ausport.gov.au/scorsresearch/research.asp. Accessed 7/10/07.

2. Review of the literature

According to ERASS, yoga participation more than doubled between 2001 and 2004, then fell by approximately 15% between 2005 and 2006, then remained relatively consistent in 2007, although it should be noted this was also in the context of reductions in participation in other sports and activities with the overall sport/activity participation rate falling from 83.3% to 80.5% between 2005 and 2006. Of the 22 most popular activities, only Australian Rules football and bushwalking recorded larger falls in participation than yoga between ’05 and ’06. Weight training recorded the largest gain.

In the absence of any other explanation, these figures suggest that yoga partidcipation may have peaked at 3.4% between 2004 and 2005, which is in line with anecdotal comments from those in the yoga industry that there was a large increase in yoga popularity between 2001 and 2004. It remains to be seen whether yoga participation will return to 2001 levels, however this seems unlikely given the 2007 participation rate remaining steady at 2.8%.

Table 2.3.4 below presents the key findings of ERASS as they relate to yoga by year, once again using Australian Rules for comparison. Interestingly, male participation in yoga fell substantially (by about half) between 2005 and 2006, returning close to 2001 levels, and then increased again in 2007. Other than the possible influences previously mentioned, these large fluctuations in participation are unexplained but may suggest that yoga participation is highly subject to community perceptions and trends.

Unfortunately, ERASS included Pilates in the yoga category, adding another layer of uncertainty to the participation rate for yoga and the reasons for fluxuations in the figures. The prevalence of Qi Gong and Tai Chi is also unknown but likely to be part of the figure for martial arts.

The ERASS reports also found that the 35-44 age group was the most likely to practice yoga followed by the 25-34 age group, and that yoga was most commonly practised 81 times a year (once to twice a week) in 2007.

2. Review of the literature

Table 2.3.4. Participation in Exercise, Recreation and Sport (ERASS) in Australia. Summary of key findings as they relate to yoga by year

Key findings in relation to 2001 2002 2003 2004 2005 2006 2007 yoga by year: Population 15,101 15,311 15,576 15,810 16,002 16,592 16,236 15+ y.o. (000s) Participants (000s) 11,748 11,912 12,850 13,091 13,329 13,356 12,958 Overall sport participation rate 77.8% 77.8% 82.5% 82.8% 83.3% 80.5% 79.4% Yoga participants (000s) 222 464 486 542 541 487 454 Aust. Rules participants (000s) 353 379 433 450 536 445 308 Male yoga participation rate 0.4% 0.8% 0.7% 0.8% 1.0% 0.5% 0.8% Female yoga participation rate 2.5% 5.2% 5.5% 6.0% 5.7% 5.3% 4.7% Total yoga participation rate 1.5% 3.0% 3.1% 3.4% 3.4% 2.9% 2.8% Aust. Rules participation rate 2.3% 2.5% 2.8% 2.9% 3.4% 2.7% 1.9% Proportion of women to men in 85.6% 86.8% 89.7% 88.2% 84.7% 91.4% 82.9% yoga Organised attendance only (class 1.0% 1.8% 2.1% 2.4% 2.0% 1.6% 1.6% attendance) Non-organised only (home 0.6% 1.4% 1.4% 1.3% 1.6% 1.6% 1.5% practice) Participation in yoga by age group: 15-24 1.9% 3.1% 2.9% 2.0% 1.8% 1.6% 1.4% 25-34 2.1% 4.0% 4.4% 4.7% 4.1% 3.7% 3.7% 35-44 1.4% 2.9% 3.1% 5.0% 4.7% 4.1% 3.7% 45-54 1.7% 4.1% 3.7% 4.0% 4.2% 2.9% 3.5% 55-64 0.9%* 2.4% 2.8% 2.9% 3.4% 3.4% 2.7% 65+ 0.6%* 1.3% 1.4% 1.2% 1.7% 1.9% 1.4% Participation in yoga by no. of times practised per year: 1-6 0.2% 0.4% 0.3% 0.3% 0.2% 0.2% 0.3% 7-12 0.1%* 0.3% 0.4% 0.2% 0.3% 0.3% 0.2% 13-26 0.2% 0.4% 0.2% 0.4% 0.4% 0.3% 0.4% 27-52 0.5% 1.2% 1.2% 1.2% 1.2% 1.3% 0.9% 53-104 0.2% 0.3% 0.5% 0.7% 0.7% 0.4% 0.5% More than 104 0.2% 0.5% 0.6% 0.7% 0.5% 0.4% 0.5% * relative standard error of between 25-50% - figure is unreliable Source: This table presents composite figures from the Australian Sports Commission ERASS reports referenced in this section.

2. Review of the literature

2.3.1.3. YogaJournal.com - Yoga in America Survey 2003 and 2005 YogaJournal.com, the pre-eminent online yoga magazine worldwide, released two ‘Yoga in America’ studies published in June 200332 and February 200533 respectively, each time commissioning Harris Interactive Service Bureau to poll a statistically representative sample of the US population (over 4700 people). The Yoga in America studies provide information on both participation in, and practice of yoga. Table 2.3.5 below provides a summary of selected findings as chosen for publication by Yoga Journal.

Table 2.3.5. YogaJournal.com - Yoga in America 2003 and 2005

YogaJournal.com - Yoga in America 2002-03 2004-05 selected findings: Participation rate 7.0%, up 28.5% 7.5%, up 43% in 1 year in 2 years Proportion of women in yoga 76.9% 77.1% Intend to try yoga in next 12 months 17% 14% Very or extremely interested in yoga >12% - At least a casual interest in yoga More than half - Household income Over 30% - US$75K, 15% over $100K Some college education or associate degree 40% - Completed college education or higher Nearly 50% - Practised for less than 1 year - 35.8% Practised for less than 2 years 58.4% 44.7% Practised for more than 10 years 15.4% - Practised two times or more per week More than half - Participation by age group: - 18-24 - 29.1% (fastest growing age group up 46%) 25-34 25.2% - 35-44 15.7% 41.6% 45-54 26.9% Source: This table presents composite figures from the Yoga Journal studies referenced in this section.

The participation rate of 7.5% in the USA in 2004-05 was higher than in Australia according to ERASS (3.4%), which may relate to unknown sampling and methodological differences between the studies, or may confirm anecdotal reports of higher rates of participation in yoga in the US. Specifically, the Yoga Journal data was collected as part of a yoga-related investigation, whereas the ERASS data was collected as part of an investigation into sport and physical activity. Given that yoga is also practised as a spiritual path and as a lifestyle, it is reasonable to presume that surveys of sport and physical activity may not result in all yoga practice being reported. More information on this follows in the next section.

The proportion of men practising yoga in the USA in 2004-05 (22.9%) was also substantially higher than in Australia during the same period (15.3%). This could relate to a greater uptake in the USA of certain styles of yoga known to appeal to men.

32 YogaJournal.com. Yoga in America. http://www.yogajournal.com/about_press061603.cfm. Accessed 24/11/05. 33 YogaJournal.com. Yoga in America. http://www.yogajournal.com/about_press020705.cfm. Accessed 9/05/06.

2. Review of the literature

2.3.1.4. American Sports Data Inc. Superstudy by Sports Participation 2003

Also in the US, the 16th annual American Sports Data (ASD) Superstudy by Sports Participation, conducted among 15,063 people over the age of six years in 2003, found that since 1998:

The greatest increase in exercise/activity in America was in yoga, elliptical motion trainers (cross trainers), stationary recumbent cycling (exercise bikes) and pilates; Pilates increased 92% over the 2001 level, with 90% of participants being women. About 67% were first-year converts to exercise; Yoga or Tai Chi (a combined category) increased by 95% over the period 1998 to 2002. About 4.4% of the population participated in yoga and 83% of participants were women; The average age of yoga participants declined from 41.5 years in 1998 to 37.1 years in 2002. In the same period, the age of pilates participants declined from 43.6 to 35.1 years.

ASD reported that 26% of Americans claimed to be experiencing “a lot of stress.” This led to the report by-line, “Kinder, gentler fitness trends continue to displace traditional exercise forms.34” Other methodological considerations are unknown.

2.3.1.5. Sport England. Women’s Participation in Sport 2002 In the UK, Sport England published a fact sheet in 2002 entitled, ‘Women’s Participation in Sport’, based on the findings of a number of surveys carried out by Sport England and others over the previous seven years. The most notable of these reports was the General Household Survey (GHS) conducted by the Office for National Statistics in 199635.

According to participation data available from the GHS, 77% of adult women (aged 16+) participated in sport at least once a year, and 56% took part at least once a month.

The most popular activity for women was walking, with 41% going for a walk or hike of at least two miles for pleasure each month. Excluding walking from the participation rates, 60% of women took part in sport on an infrequent basis and 38% took part on a frequent basis.

The GHS showed that more men participated in sport than women. Including walking, 87% of men participated on an infrequent basis and 71% participated on a regular basis (at least once a month). Excluding walking, these figures fell to 73% and 54% respectively.

Other than walking, women were most likely to take part in keep fit/yoga (17%; a combined category), swimming (17%), and cycling (8%) on a regular basis (at least once a month). For men, the most popular activities (excluding walking) were cue sports (20%), cycling (15%) and swimming (13%). Men had higher participation rates than women in all activities with the exception of swimming, keep fit/yoga, horse riding, iceskating, and netball.

Unfortunately, the Sport England data combined yoga with the ‘keep fit’ category, limiting comparison with other yoga studies, however this study is relevant by way of comparison with Australian sports participation data.

34 American Sports Data, Inc. Superstudy by Sports Participation. http://www.americansportsdata.com/pr_04-15-03.asp Accessed 16 June 2004. 35 Sport England. Women’s Participation in Sport Factsheet. 2002. http://www.sportengland.org/womens_participation_factsheet.pdf Accessed 16 June 2004.

2. Review of the literature

2.3.1.6. Australian Institute of Health and Welfare. Physical Activity Patterns of Australian Adults 2000 The Australian Institute of Health and Welfare (AIHW) reported the results of the 1999 National Physical Activity Survey36, focussing on sessions of activity rather than activities undertaken. No yoga-specific data was available, although interestingly, the survey reported that only 65% of men and 57% of women achieved sufficient levels of physical activity over the previous six months to confer a health benefit. Sufficient levels were defined as 150 minutes of activity per week with high intensity physical activity weighted 2:1. The AIHW noted that the proportion of people engaging in sufficient levels of activity to confer a health benefit had declined by five percentage points between 1997 and 1999. This trend occurred despite an increase in availability of information on the health benefits of regular exercise during the same period. This study and those below, while not specific to yoga, are relevant in the context of physical activity discussed later in this document.

2.3.1.7. Behavioral Risk Factor Surveillance System. USA 2003 In 2003, the National Center for Chronic Disease Prevention and Health Promotion in the US published a report based on the results of the Behavioral Risk Factor Surveillance System (BRFSS). The BRFSS is an on-going population-based, random digit dialed telephone survey of the U.S. population aged 18 years and over, with a large sample size of 205,140 in 2001 and 180,244 in 200037. Respondents were asked to report the frequency and duration of the two leisure-time or physical activities they most commonly participated in during the preceding month. The report found that the majority of people in the United States did not engage in physical activities consistent with the recommendation of a minimum of 30 minutes of moderate-intensity activity on most days of the week. In 2001, 54.6% of respondents were not active enough to meet these recommendations.

2.3.1.8. National Heart Foundation of Australia. Position paper on physical activity 2001 The National Heart Foundation of Australia (NHF), in its 2001 position statement on physical activity advised, “all people should aim to participate in moderate intensity physical activity for 30 minutes or more on most or all days of the week. While this level of moderate physical activity is recommended for health benefit, more vigorous activity (for those who are able and want to do it) may confer additional benefit in terms of cardiovascular health. 38”

2.3.1.9. Nutrition Australia. Activities and activity levels for general health and well-being 1999 In a position statement, Nutrition Australia recommended walking, swimming and bike riding, but also mentioned yoga and Tai Chi as activities that promote psychological health at the same time as enhancing flexibility39.

36 Australian Institute of Health and Welfare, 2000: Physical Activity Patterns of Australians Adults. Results of the 1999 National Physical Activity Survey. Aust Institute of Health and Welfare Cat No. CVD 10, Canberra. http://www.aihw.gov.au/publications/health/papaa/papaa.pdf. Accessed 6/10/07. 37 Macera CA, Jones DA, Ham SA, Kohl HW, Kimsey CD, Buchner D. Prevalence of physical activity, including lifestyle activities among adults – Centres for Disease Control and Prevention, United States, 2000-2001. 38 National Heart Foundation of Australia Physical Activity Policy. A position paper prepared by the National Physical Activity Program Committee, National Heart Foundation of Australia, April 2001. 39 Nutrition Australia Fact Sheet. What types of activities and activity levels are appropriate for general health and wellbeing? August 1999.

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2.3.2. Participation in yoga as a form of therapy

In contrast to participation in yoga as a physical activity, studies into the use of complementary and alternative medicine (CAM) also provide an insight into yoga participation. As mentioned earlier, yoga can be practised as a physical activity, a therapy, a spiritual path, and a way of life.

2.3.2.1. Complementary and Alternative Medicine Use in Australia in 2005: A National Population Based Survey In a national, random telephone survey of a statistically representative sample of the Australian population (1067 people), the prevalence of yoga as a CAM therapy for a 12 month period in 2005 was found to be 6.8% for practitioner visits (e.g. attending a yoga class), and 12.0% for all use of yoga including practitioner visits and home practice40. The 95% confidence intervals for these results were between 5.74% and 7.90%, and between 10.1% and 13.9% respectively.

Although men and women were equally represented in the random sample of the population, 74.4% of women were CAM users, compared to 63.4% of men. The authors reported that the greatest gender differences in use of CAM were in aromatherapy, western herbal medicine, massage, naturopathy, energy healing and yoga. In addition, the younger 18-34 age group was reported to have a higher prevalence of CAM use, largely because of their use of yoga, Qi Gong, Tai Chi and clinical nutrition.

It is interesting to note that this study put yoga participation in Australia at two to three times higher than the participation rates in the ERASS and ABS data; however, it is more consistent with the 7.5% of Americans found to be practising yoga by the 2005 Yoga in America survey. It is not possible to directly compare participation rates from these studies due to unknown methodological differences, however a cursory comparison once again suggests that studies into sports and physical activity may understate all yoga participation.

2.3.2.2. Integration of Complementary Therapies in Australian General Practice: Results of a National Survey A national survey of Australian General Practitioners (GPs) 41, reported that complementary therapies can be seen as belonging to one of three distinct groupings: 1) non-medicinal and non-manipulative therapies such as acupuncture, massage, meditation, yoga and hypnosis; 2) medicinal and manipulative therapies such as chiropractic, Chinese herbal medicine, osteopathy, herbal medicine, vitamin and mineral therapy, naturopathy and homeopathy; and 3) esoteric therapies such as spiritual healing, aromatherapy, and reflexology. Group 1 therapies were seen by doctors as both highly effective and safe, while Group 2 therapies were considered to be more potentially harmful than potentially effective. Group 3 therapies were seen to be relatively safe but also relatively ineffective.

The authors reported that Group 1 therapies, which included yoga and meditation, were widely accepted in Australian general practice. Referral of patients to, or suggestion to patients to use yoga or meditation in the previous 12 months, was reported by 62% and 65% of GPs respectively. The only therapies receiving a higher rate of referral or suggestion were massage (87%) and acupuncture (83%). About 10% of GPs said they practised yoga or meditation themselves, and 13% and 26% reported previous some training in yoga and

40 Xue, CCL. Zhang AL, Lin V et al. (2007) Complementary and Alternative Medicine Use in Australia: A National Population Based Survey. The Journal of Alternative and Complementary Medicine. July 2007, Vol 13:6 pages 643-650. 41 Cohen M, Penman S, Pirotta M, Da Costa C. Integration of Complementary Therapies in Australian General Practice: Results of a National Survey. J Alt Comp Med. 2005 Dec; 11(6):995-1004.

2. Review of the literature

meditation respectively. One third were interested in receiving further training in yoga and 43% were interested in training in meditation.

This study confirmed the results of earlier surveys of Perth GPs in 200042 and Victorian GPs in 199743,44.

2.3.2.3. The escalating cost and prevalence of alternative medicine (in Australia) 2000 A South Australian study of 3027 people over the age of 15 years in 200045, as a follow-up to a similar 1993 study46 investigating the prevalence of CAM use, estimated the out-of-pocket spending on alternative medicines and therapies at A$2.3 billion in 2000, nearly four times the public contribution to the cost of pharmaceuticals.

CAM users were more likely to be female, better educated, employed and have a higher income. Nearly one quarter (23.3%) of respondents had visited at least one alternative practitioner in the previous 12 months, with higher use of acupuncturists, reflexologists, aromatherapists, and herbal therapists. Although yoga-specific data was not reported, this study is relevant in the context of the characteristics of CAM users and their usage of, and spending on, CAM therapies which include yoga and meditation.

2.3.2.4. Use of mind-body medical therapies (USA) 2004 A US study reported that 18.9% of adults had used at least one mind-body therapy in the previous year, with 20.5% of these involving visits to a mind-body professional47. Meditation, imagery, and yoga were the most commonly used techniques. While used for the full array of medical conditions, they were used most frequently for chronic pain (used by 20% of those with chronic pain) and insomnia (used by 13% of those with insomnia), ”Conditions for which consensus panels have concluded that mind-body therapies are effective.” The authors also reported that, “They were used by less than 20% of those with heart disease, headaches, back or neck pain, and cancer, conditions for which there is strong research support.”

42 Hall K, Giles-Corti B. Complementary therapies and the General Practitioner. A survey of Perth GPs. Aust Fam Physician 2000; 29(6):602-6. 43 Pirotta M, Farish SJ, Kotsirilos V, Cohen MM. Characteristics of Victorian general practitioners who practise complementary therapies. Aust Fam Physician. 2002 Dec;31(12):1133-8. Review. 44 Pirotta MV, Cohen MM, Kotsirilos V, Farish SJ. Complementary therapies: have they become accepted in general practice? Med J Aust. 2000 Feb 7;172(3):105-9. 45 MacLennan AH, Wilson DH, Taylor AW. The escalating cost and prevalence of alternative medicine. Prev Med. 2002 Aug;35(2):166-73. 46 MacLennan AH, Wilson DH, Taylor AW. Prevalence and cost of alternative medicine in Australia. Lancet 1996; 347(9006):972-3. 47 Wolsko PM, Eisenberg DM, Davis RB, Phillips RS. Use of mind-body medical therapies. J Gen Intern Med 2004; 19(1):43-50.

2. Review of the literature

2.3.2.5. Complementary and Alternative Medicine Use Among Adults: United States 2002 In a report based on 31,044 interviews of adults 18 years of age and over, adjusted to the U.S. standard population in the year 2000, yoga was listed as one of the 10 most commonly used CAM therapies, with 5.1% of the population having used yoga during the prior 12 months48. This figure increased to 7.5% for having ‘ever used’ yoga. However, frequency of practice was not reported. The most commonly used CAM therapy was ‘prayer’ (for one’s own health), at 43%.

The rest of the data combined yoga with other therapies, limiting comparisons with other studies. Table 2.3.6 summarises the results in relation to yoga.

Table 2.3.6. Complementary and Alternative Medicine Use Among Adults: United States 2002

Most commonly used CAM therapies: Prayer for one’s own health 43.0% Prayer by others for one’s own health 24.4% Natural products 18.9% Deep breathing exercises 11.6% Participation in a prayer group for one’s own health 9.6% Meditation 7.6% Chiropractic care 7.5% Yoga 5.1% Massage 5.0% Diet-based therapies 5.5%. Top five conditions (irrespective of therapy) treated with CAM: Back pain or problem 16.8% Head or chest cold 9.5% Neck pain or problem 6.6% Joint pain or stiffness 4.9% Anxiety/depression 4.5% Reasons for trying Yoga, Tai Chi or Qi Gong: Conventional medical treatments would not help 30.9% Conventional medical treatments were too expensive 14.4% Therapy + conventional medical treatments would help 52.3% Suggested by a conventional medical practitioner 21.0% Thought it would be interesting to try 59.2% Source: This table presents composite information from the Barnes et al Advance Data Report (2002) referenced in this section.

The report also described the extent of use of ‘mind-body therapies’ (a combined group comprising biofeedback, meditation, guided imagery, progressive relaxation, deep breathing exercises, hypnosis, yoga, Tai Chi, yoga and Qi Gong) by sex, age group, race, socio- economic status. However, because the group definition was broad, no information was available specifically in relation to yoga or meditation.

48 Barnes P, Powell-Griner E, McFann K, Nahin R. CDC Advance Data Report #343. Complementary and Alternative Medicine Use Among Adults: United States, 2002. May 27, 2004.

2. Review of the literature

2.3.2.6. Prevalence and Patterns of Adult Yoga use in the United States: results of a national survey A study of a nationally representative sample of 2055 telephone interviews49 provided comparisons to an earlier study by the same authors50. The researchers found that 7.5% of respondents had ‘ever used’ yoga, while 3.8% had used yoga at least once in the previous 12 months. Respondents who used yoga at least once were more likely than non-users to be female (68% compared to 51%), college educated (68% to 45%) and urban dwellers (93% to 74%)51.

Other factors independently associated with yoga use at least once were: the baby boomer age group, education beyond high school, residing in small or large metropolitan areas rather than rural areas, and use of other CAM therapies.

Of the respondents who reported using yoga at least once in the previous 12 months, 64% used yoga for wellness, 48% for health conditions, and 21% specifically for back or neck pain. Nearly all (90%) felt yoga was somewhat helpful and 76% did not report spending money related to their yoga (e.g. home practice).

The researchers concluded that in 1998 an estimated 15 million American adults had used yoga at least once in their lifetime, and 7.4 million had done so in the previous year.

2.3.2.7. World Health Organisation. Prevalence of use of complementary/alternative medicine: a systematic review 2000 A worldwide review of more than 100 studies of CAM use for the World Health Organisation (WHO) excluded all but 12 studies because the samples were neither random nor representative52. Of the 12 studies accepted for review, only Haidinger53 (Austria), Astin54 (USA) and the Eisenberg/Saper (USA) studies described earlier, provided any yoga-specific information, but were limited to ‘ever used’ or ‘used at least once in the previous 12 months’ data.

49 Eisenberg DM, Davis RB, Ettner SL, Appel S, Wilkey S, Van Rompay M, Kessler RC. Trends in alternative medicine use in the United States, 1990-1997: results of a follow-up national survey. JAMA 1998; 280(18):1569-75. 50 Eisenberg DM, Kessler RC, Foster C, Norlock FE, Calkins DR, Delbanco TL. Unconventional medicine in the United States. Prevalence, costs and patterns of use. N Engl J Med 1993; 328(4):246-52. 51 Saper RB, Eisenberg DM, Davis RB, Culpepper L, Phillips RS. Prevalence and patterns of adult yoga use in the United States: results of a national survey. Alt Ther Health Med 2004; 10(2):44-9. 52 Ernst E. Prevalence of use of complementary/alternative medicine: a systematic review 2000. Bulletin of the World Health Organisation 2000; 78(2)252-257. 53 Haidinger G, Gredler B. Extent of familiarity with, extent of use of, and success of alternative therapies in Austria. Offentliche Gesundheitswesen 1998, 50:9-12 (in German). 54 Astin JA. Why patients use alternative medicine: results of a national study. JAMA 1998; 279:1548-1553.

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2.4. Practice Studies

Studies on the practice of yoga are often reflective of a particular school or style of yoga limiting generalisability, sometimes of low methodological rigour. At the time of writing, there were no national practice studies in Australia other than those described below.

2.4.1. Medibank Private Australia. Sports Injuries Report 2004 In 2004, Medibank Private (the largest Australian private health insurer) reported that, “more than one quarter of all participants surveyed had been injured while practising yoga. 55" The headline grabbed media attention around the country, suggesting that yoga was a relatively dangerous pastime. On further investigation, the market research firm employed by Medibank Private advised that the sample was 727 Medibank Private customers, interviewed by telephone; of whom 3%, or 18 participants, reported practising yoga in the previous 12 months. Of those, four participants (about 25%) reported having sustained an injury from yoga in the past two years with one other person reporting an injury from yoga in the past five years56. No details were available as to the definition of a yoga injury used, or the nature of the injuries reported. Other factors that may have influenced the results are unknown.

Following protests from yoga teachers and yoga teacher groups around the country, Medibank Private removed that section on yoga injuries from the report in early 2005, demonstrating an urgent need for reliable figures in this area.

2.4.2. Dru Yoga. Practitioner survey UK and Australia 2006 A survey of 440 Dru yoga practitioners, primarily in the UK and Australia, asked 34 questions focusing on the perceived physical, mental and emotional benefits of Dru yoga practice57. Dru yoga is based on soft, flowing movements, controlled breathing and visualisation.

About one third (35%) of respondents were either Dru yoga teachers or in training to become teachers, with the remainder being yoga practitioners (students). The majority of respondents were women (78%) aged 30-60 years. Interestingly, only 53% of respondents said they practised more than once every 5 days.

Table 2.4.1 below summarises the results. Please note that the percentage of respondents shown includes those who responded ‘slight’ or ‘strong’.

55 Medibank Private. Sports Injuries Report 2004. http://www.medibank.com.au/healthandwellbeing/sports_injuries_report.asp. Accessed 3/8/04. 56 Australian Yoga Life. Issue 10, November 2004. Yoga Injuries Don’t Add Up, article by Suzanne Eggins. 57 Dru Course Centre, Life Foundation School of Therapeutics, UK. http://www.druexperience.org.

2. Review of the literature

Table 2.4.1. Dru Yoga Practitioner survey UK and Australia 2006

Percentage of respondents ‘slight’ or ‘strong’ Better able to handle stress 89% Better able to handle negative thoughts 93% Positive change in back pain 72% Boost in energy levels 85% Improvement in strength and stamina 82% Improved body awareness 92% Greater flexibility in spine and joints 93% Improvement in overall body tension 84% Improved breathing 88% Improved balance 86% Improved sleep pattern 69% Better ability to handle emotions 83% Positive shift in mood 84% Better ability to deal with conflict 73% Higher levels of serenity 79% More patient and open with others 79% More tolerant towards others 82% Greater feelings of compassion for others 76% Positive improvement in communication skills 74% Better family relationships 74% Better social relationships 68% Better experiences in the workplace 68% Better able to change unhealthy lifestyle habits 72% Greater clarity of purpose 74% Feel more confident 81% Have more courage 75% Feel more creative and intuitive 72% Others commented on changes they noticed in the participant Nearly half Source: This table presents composite information from the Dru Yoga study referenced in this section.

2.4.3. YogaJournal.com. What the Future Holds: Yoga 2030 Survey In an online reader survey aiming to present a view of how yoga might be practised in the future58, Yoga Journal asked readers a wide range of questions about their practice, summarised in Table 2.4.2.

Being a readership survey, results can be assumed to reflect the characteristics of online Yoga Journal readers, and as for other practice studies, of those readers sufficiently motivated to participate in the survey, e.g. respondents are likely to be biased towards yoga while the characteristics of non-respondents are unknown. The demographic and socioeconomic characteristics of respondents and non-respondents were not available for comparison.

58 Yogajournal.com. What the Future Holds: Yoga 2030 Survey. http://www.yogajournal.com/extra/1672.cfm. Accessed 10/9/05.

2. Review of the literature

Table 2.4.2. What the Future Holds: Yoga 2030 Survey

Length of practice (n=1835): (percentage of respondents) Less than 1 year 15.5% 1-2 years 20.6% 2-5 years 36.6% 5-10 years 16.6% More than 10 years 10.7% Those attending classes (n=1409) primarily attended a: Yoga studio or centre 66.1% Health club/gym 22.0% Private instructor 4.6% Retreat centre or spa 0.9% Other 6.3% Interest in yoga (n=1949) was rated as: Somewhat interested 3.2% Very interested 38.5% Extremely interested 58.3% Motivators (perceived benefits) for practice: (number of respondents) Flexibility 1733 Stress reduction 1607 Strength 1583 General fitness 1470 Personal growth 1438 Mental health 1385 Spiritual development 1300 Weight loss 688 Specific health condition 445 Pre-natal health 57 Styles of yoga practised: (number of respondents) Vinyasa flow 694 Ashtanga 651 Iyengar 494 Power yoga 418 Bikram 153 Anusara 149 Kundalini 116 Sivananda 71 Jivamukti 50 Other 456 Significant hybrid styles practised: (number of respondents) Yogalates 217 Freestyle vinyasa flow 95 Nude yoga 42 Have you ever read the following yoga texts? (number of respondents) Patanjali’s Yoga Sutras 582 Bhagavad Gita 528 Upanishads 199 Hatha Yoga Pradipika 163 Have you ever been on a yoga/meditation retreat? (n=1728) Yes 25.5% Length of last retreat (n=500): 3-5 days 54.8% 1 week 21.4% 2 weeks 6.8% 1 month 5.8% Longer 11.2% Source: This table presents composite information from the Yoga Journal 2030 study referenced in this section.

2. Review of the literature

Other information reported by the 2030 survey is shown in Table 2.4.3 below.

Table 2.4.3. YogaJournal.com. What the Future Holds: Yoga 2030 Survey

Frequency of Do you attend Do you Practice practice yoga classes? meditate? Pranayama? (n=1991) (n=2067) (n=1725) (n=1700) Yes 71.8% Yes 67.1% Yes 66.0% How often? How often? How often? (n=1413) (n=1397) (n=1371) 5 or more times 31.2%* 9.2% 19.9% 22.3% a week 2-4 times a 55.4%* 50.3% 32.7% 36.1% week Once a week 10.1%* 31.6% 18.2% 16.5% Once a month missing data 5.7% 7.9% 4.6% Less than once 1.3%* 2.7% 6.9% 4.5% a month Not in the last 6 2.0%* 0.6% 14.3% 15.9% months *Percentages may be inaccurate due to missing data Source: This table presents composite information from the Yoga Journal 2030 study referenced in this section.

Participants were also asked to indicate their agreement with a range of statements about yoga and the future of yoga. For example, ‘Being a yogi means being vegetarian,’ to which 87.7% of 1724 respondents answered ‘No’. The study also found that 4.6% of 1704 respondents had traveled to India to study yoga or meditation.

Yoga Journal also holds weekly polls on its website, one of which offered some insight into the reasons why men are not as likely to practice yoga as women59.

Why are men more reluctant to do yoga than women? (n=1477)

Don't think they will get a good enough workout 31% Aren't interested in the quiet, non-competitive aspects of yoga 25% Fear of embarrassment in class 34% Unaware that yoga is an option for health and healing 10%

59 YogaJournal.com Newsletter. http://www.yogajournal.com/newsletter/myj_58.html. Accessed 7/10/07.

2. Review of the literature

2.4.4. British Wheel of Yoga. National Members Survey 2003 In the UK, the British Wheel of Yoga (BWY) is the largest yoga organisation with a nationwide network of over 3000 teachers. It is recognised by the Sports Councils as the national governing body for yoga in the UK. BWY is also the national representative at the Executive of the European Federation of National Yoga Organisations.

In 2003, BWY conducted a National Members Survey in which it canvassed members’ attitudes to the organisation60. A total of 1650 members responded, representing 23% of the BWY membership, of whom about 850 were yoga teachers. Some data in relation to members’ personal yoga practice and teaching was reported, as shown in Table 2.4.4.

Table 2.4.4. British Wheel of Yoga. National Members Survey 2003

Attended a weekly yoga class 69% Had been practising yoga for 20+ years 41% Members of BWY for between 2-5 years 26% Have a name for their style of teaching, 70% most commonly: Hatha 47% Viniyoga 10% BWY 8% Teach more than once a week and teach an average of between 51% 21-50 students each week Source: This table presents composite information from the BWY study referenced in this section.

Considering that BWY membership is open both to yoga teachers (teaching or non-teaching) and people who practice yoga (presumably enthusiasts), the above information must be interpreted in that context.

60 British Wheel of Yoga. National Members Survey 2003. http://www.bwy.org.uk/. Accessed 18 June 2004. (no longer available).

2. Review of the literature

2.4.5. Manchester Yoga Survey 2000 Table 2.4.5 shows selected findings of a survey of over 900 practitioners of Iyengar yoga in Manchester in 200061.

Table 2.4.5. Manchester Yoga Survey 2000

Mean age 46 (range 14-82) Proportion of women 88% Working 64% Mean years of practice 6.8 (range 0-40) Practised less than 1 year 36% Practised at home 34% Reason for starting yoga practice (on a scale from 0-9): Health/fitness 8 Fun/social 4 Help with a specific problem 4 (41%) Spiritual development 3 Of those who started for help with a specific problem: Physical 41% (more men than women) Stress-related 33% (twice as many women as men) Sleep-related 13% Source: This table presents composite information from the Manchester Yoga Survey referenced in this section.

Health conditions of participants were reported as, “back pain, arthritis, joint injuries (knee, shoulder, hip, neck), stiffness, postural problems, restricted mobility, circulatory disorders, menopause, PMT, mastectomy, asthma, ME, MS, tension, depression, nervous breakdown, headaches, and inability to relax.”

The researchers reported that, “Respondents who reported problems were asked to score on a scale of increasing severity (0-9) the extent of their problem at the time of starting yoga and how it was at the time of the survey. Overall, a mean improvement of 2.6 points was seen, a strongly positive result. Benefit increased both with the number of classes attended per month and with home practice.”

Only minor injuries from yoga practice were reported (e.g. aches, strains and muscle problems). Injuries were more likely in home practice and more likely in those who reported a physical problem for starting yoga. They were twice as likely in men and more common in middle age.

61 Manchester Yoga Survey. http://www.aplin.man.ac.uk/survey.html. Accessed 6/10/07.

2. Review of the literature

2.4.6. YogaSite.com 1998 An online survey of 200 people conducted by YogaSite.com in 199862 found that, “Today's yoga practitioner is most likely a woman in her mid-thirties who does yoga three to five times a week, has been practising for less than two years and believes in reincarnation. Although not a vegetarian, she watches what she eats, goes to class at a local yoga center, has never been on a retreat, and is more into physical/mental fitness than enlightenment. She thinks she's in better shape than the average American, often gets stressed or anxious, is more likely to vote than most people, and makes between $30,000 and $50,000 a year.”

Other findings of the YogaSite survey are summarised in Table 2.4.6 below.

Table 2.4.6. YogaSite.com 1998

90% or more practice asana 90% or more Median age 34 Proportion of women 64% Practice asana everyday 19% Majority practice 3-5 times a week Practising for less than 2 years 58% Length of practice sessions: 30-60 minutes 47% 60-90 minutes 41% Have a teacher (attend class or private instructor) 57% Have no teacher (home practice) 39% About half meditate and fewer practice pranayama Vegetarian 38% vegetarian Believe in reincarnation 46% (35% not sure) Feel anxious or stressed often 68% Personal view of yoga: Primarily a spiritual discipline 42% Mental and/or physical fitness program 56% Stress relief 55% Source: This table presents composite information from the YogaSite.com Survey referenced in this section.

2.4.7. Other practice studies in progress at time of writing

Yoga Injuries survey63. A survey to identify the most common injuries attributable to yoga regardless of whether they occur in class or elsewhere, and their likely causes, supported by the International Association of Yoga Therapists, Yoga Alliance and others.

Youth Yoga survey64. A survey to gather general information from yoga teachers who are teaching and/or practising with children and teens (4-18 y.o.) throughout the USA.

62 YogaSite.com. http://www.yogasite.com/surveyreport.html. Accessed 6/10/07. 63 Sciatica.org. http://www.sciatica.org/yoga_injury_survey.html. Accessed 8/1/08. 64 Iyengar Yoga of Germantown. http://www.germantownyoga.com/surveyintro.htm. Accessed 6/10/07.

2. Review of the literature

2.5. Effectiveness studies

2.5.1. Introduction In the popular book, ‘Light on Yoga,’ BKS Iyengar describes “curative asanas for various diseases.” Yogic practices such as asana (postures), pranayama (breathing techniques), kriya (cleansing practises), and dhyana (meditation) are detailed for some 88 diseases or health conditions for which yoga has traditionally been used, including arthritis, asthma, back pain, high blood pressure, bronchial disorders, epilepsy, diabetes, coronary artery disease and sciatica65. However, it has only been in recent decades that mind-body practices such as yoga and meditation have gained acceptance in the western world as part of an integrative approach to health care.

Complementary and alternative medicine (CAM) as defined by the National Centre for Complementary and Alternative Medicine (NCCAM) in the USA, is “a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine.66” The list of therapies considered to be CAM changes continually and is geographically dependent. However, yoga is commonly considered a CAM therapy along with acupuncture, aromatherapy, Chinese herbal medicine, chiropractic, homoeopathy, hypnosis, massage, meditation, naturopathy, osteopathy, reflexology, spiritual healing, and vitamin and mineral therapy.

In Australia, meditation and yoga were found to have similar levels of acceptance amongst GPs as acupuncture, hypnosis and massage67, however, anecdotal evidence suggests that these therapies are not widely used in the prevention, management and treatment of heart disease and other conditions for which there is research support68.

Interestingly, the bulk of scientific research into the therapeutic use of yoga and meditation relates to many of the same conditions Iyengar describes in his book as traditionally treated with yoga, with the addition of some more modern lifestyle diseases. These conditions include stress, anxiety disorders, depression, the risk factors for cardiovascular disease (overweight, high blood pressure, high cholesterol), asthma, and diabetes, in addition to the more obvious application of yoga for musculoskeletal conditions, such as chronic back pain and joint conditions like fibromyalgia and arthritis, flexibility and strength, and general health and well-being.

A search of PubMed, the public information service of the US National Library of Medicine and the National Institutes of Health, jointly with the National Centre for Biotechnology Information (NCBI)69, was conducted in July 2004 and again in January 2008, to identify the conditions for which research into yoga and meditation has been conducted, using a range of keywords as shown in Table 2.5.1.

65 Iyengar BKS. Light on Yoga. Harper Collins Publishers 2001. 66 National Centre for Complementary and Alternative Medicine. What is CAM? http://nccam.nih.gov/health/whatiscam/. Accessed 15/1/08. 67 Cohen M, Penman S, Pirotta M, Da Costa C. Integration of Complementary Therapies in Australian General Practice: Results of a National Survey. J Alt Comp Med. 2005 Dec; 11(6):995-1004. 68 Wolsko PM, Eisenberg DM, Davis RB, Phillips RS. Use of mind-body medical therapies. J Gen Intern Med 2004; 19(1):43-50. 69 National Centre for Biotechnology Information. http://www.ncbi.nlm.nih.gov/ Accessed 10/1/08.

2. Review of the literature

Table 2.5.1. Pubmed keyword search, January 2008

Yoga Meditation ‘Yoga’ or ‘meditation’ keyword only 1016 1420 ‘Yoga’ or ‘meditation’ + other keywords: (Actual keyword or phrase in italics) Attention Deficit Hyperactivity Disorder 78 5 Arthritis 14 8 Anxiety 78 198 Asthma 54 13 Back pain 27 14 Cancer 37 104 Chronic pain 28 33 Coronary artery disease 15 13 - Cardiovascular disease 70 68 - Heart disease 42 61 Carpal tunnel syndrome 18 0 Cognitive function 44 139 Depression 63 109 Diabetes 28 16 Epilepsy 17 27 Hypertension 69 89 - high blood pressure 80 102 Hyperlipidemia 3 2 - high cholesterol 20 14 Irritable bowel syndrome 6 5 Menopause 11 4 Motor skills 2 6 Multiple sclerosis 8 2 Obesity 15 8 Obsessive Compulsive Disorder 7 7 Pain management 8 12 Pancreatitis 2 0 Pregnancy 24 13 Premenstrual syndrome 1 11 Sleep disorders 39 79 Stress management 140 337 Weight management 54 38

Given that automated searches simply count occurrences of terms in the titles, authors, abstracts, and keywords of the databases indexed by Pubmed and therefore contain duplication, this exercise was primarily useful to gauge areas of research activity, but also to identify conditions for further investigation in the literature review. The 1016 results for yoga in January 2008 contained 151 clinical trials, 597 papers with abstracts, and 152 reviews. Of the 1420 results for meditation, there were 160 clinical trials, 963 papers with abstracts, and 200 reviews.

2. Review of the literature

2.5.2. The problem with CAM research There are a number of considerations that influence whether peer-reviewed research studies can be considered evidence of efficacy. These considerations, and additional issues specific to yoga and meditation research, can be summarised as follows:

Many of the published randomised controlled trials (RCTs) investigating yoga or meditation have only a small number of participants, and although they may use random assignment and/or a control group, some studies use questionable methods of recruitment, random assignment, or control.

Details of study design, methodology and data analysis may not be reported, meaning that such a study cannot be included in systematic reviews or meta- analyses, and for the same reason is unlikely to be independently replicated.

Many of the studies have been undertaken in India; therefore may be specific to the Indian population, culture and other socioeconomic considerations. Only a few have been repeated in western populations.

It is usually not possible to ‘blind’ or ‘double-blind’ a yoga or meditation intervention (where the participants and/or the researchers respectively don’t know whether they are receiving/delivering the intervention or the control), for obvious reasons. However some Transcendental Meditation (TM) studies have used comparison groups such as mindfulness training, progressive muscle relaxation or active thinking. Likewise some physical yoga interventions may be able to be controlled by comparison with physical exercise, or otherwise against waitlist controls to achieve some rigour. A ‘crossover’ design, where both groups in turn act as the intervention and the control, may also be impractical where blinding is not possible.

The interventions vary widely, drawn from a diverse range of yoga styles and practices, with little similarity between intervention designs except that the term ‘yoga’ is commonly used to describe them all. Interventions often isolate particular yoga techniques and combine them with other non-yoga techniques and best practice, e.g. ‘yoga plus usual medication’, ‘yoga breathing plus diet’ or ‘yoga plus education’. Further, details as to how the yoga intervention is designed and delivered is sometimes not reported or limited.

Funding for research into yoga, meditation and many other complementary therapies and medicines is often limited or non-existent due to the absence of large commercial organisations which stand to benefit from a positive clinical trial. This may also be a reason why many yoga studies have a small number of participants.

Yoga seems to be beneficial in many conditions for which its action may be to nurture and support the patient, rather than having a curative action on the condition itself therefore it is difficult to attribute cause and effect.

Perhaps most importantly, yoga and meditation are multifaceted physical, mental, emotional and spiritual disciplines. Therefore, when attempting to evaluate their benefits, it is often difficult to isolate or describe the mechanism by which any benefit is derived in the face of multiple variables70.

70 Caspi O, Burleson KO. Methodological challenges in meditation research. Adv Mind Body Med. 2005 Spring;21(1):4-11.

2. Review of the literature

2.5.3. Levels of evidence - measuring scientific rigour In 2001, the Oxford Centre for Evidence Based Medicine (CEBM) published a guide to categorising research in five levels71, ranging from Level 1a for a systematic review with homogeneity of variance between included RCTs, to Level 5 for expert opinion, as shown in Table 2.5.2.

Table 2.5.2. Oxford Centre for Evidence Based Medicine. Levels of evidence

Level Therapy/Prevention, Aetiology/Harm 1a Systematic review (with homogeneity) of RCTs 1b Individual RCT (with narrow Confidence Interval) 1c All or none (all died but now some survive, or, some died but now none die) 2a Systematic review (with homogeneity) of cohort studies 2b Individual cohort study (including low quality RCT; e.g. <80% follow-up) 2c ‘Outcomes’ Research; Ecological studies 3a Systematic review (with homogeneity) of case-control studies 3b Individual Case-Control Study 4 Case-series (and poor quality cohort and case-control studies) 5 Expert opinion without explicit critical appraisal, or based on physiology, bench research or ‘first principles’ Source: Oxford Centre for Evidence-based Medicine Levels of Evidence (May 2001).

Studies in this literature review have been categorised by CEBM level. However, as the majority of the studies were small RCTs (most were found to be Level 2b), the studies have been further classified by an effectiveness scale, as used in the ‘National Asthma Council Australia guide for health professionals72,’ shown in Table 2.5.3.

Table 2.5.3. National Asthma Council Australia. Effectiveness scale

Strong evidence of effectiveness 3+ Systematic review or all RCTs show statistically significant and clinically important effect, none conflicting Probably effective 2+ Majority of controlled trials show siginificant and clinically important effect Possibly effective 1+ One trial shows statistically significant effect Neutral +/- Equivocal, conflicting results, or not clinically important Possibly ineffective 1- One trial shows no significant effect Probably ineffective 2- Systematic review or majority of controlled trials exclude clinically important effect Strong evidence of lack of effect 3- Systematic review or all RCTs exclude clinically important effect 0 Insufficient evidence Source: National Asthma Council of Australia. Asthma and Complementary Therapies (2005).

71 Oxford Centre for Evidence-based Medicine Levels of Evidence (May 2001). http://www.cebm.net/index.aspx?o=1047. Accessed 15/1/08. 72 Australian Government Department of Health and Ageing; National Asthma Council of Australia. Asthma and Complementary Therapies. A guide for health professionals. 2005. http://www.nationalasthma.org.au/html/management/infopapers/health_professionals/5001_ct.asp. Accessed 15/1/08.

2. Review of the literature

2.5.4. Structure of this review There is little high-grade scientific evidence (such as high quality RCTs, meta-analyses or systematic reviews of quality RCTs) supporting yoga or meditation interventions for any condition. For example, a search of the Cochrane Database of Systematic Reviews73 for the word ‘yoga’ revealed six systematic reviews. However, only two of those specifically investigated yoga interventions (for epilepsy and carpal tunnel syndrome) and were limited by the small number of randomised controlled trials eligible for inclusion in the reviews. The other reviews were ‘Meditation therapy for anxiety disorders’, ‘Cognitive Behavioural Therapy (CBT) compared to yoga and education for Tinnitus’, ‘Exercise for anxiety and depression in young people,’ and ‘Non-surgical interventions for back pain in pregnancy.’ At the time of writing, there is also a Cochrane review at protocol stage investigating meditation therapies for Attention Deficit Hyperactivity Disorder (ADHD).

Therefore, this review of the medical and scientific literature could not be restricted to systematic reviews and high quality RCTs. Systematic reviews are included where available, but more commonly, small RCTs and in some cases, case-series and multi-centre studies where they are the best research available for a given condition.

The studies in the tables that follow have been ordered to show higher levels of evidence and more recent studies first as follows:

1. by CEBM and effectiveness level (higher levels first) 2. by year (more recent years first)

For example, a systematic review of a number of RCTs conducted in 2001 will generally appear in the table before a single RCT conducted in 2007, except where the single RCT is deemed to be of a higher quality than the quality of the RCTs included in the systematic review.

The conditions reviewed were those most commonly found in the Pubmed search described in the previous section, and those conditions most commonly reported by yoga survey participants, divided into the following broad category headings:

Cardiovascular health: Cardiovascular Disease (CVD), Hypertension, Hyperlipidemia, Metabolic (Insulin Resistance) Syndrome, Diabetes, and weight management Mental health: Stress, anxiety, anxiety disorders, mood disorders, sleep disorders, depression Musculoskeletal health: Back pain, joint pain, Arthritis and Osteoarthritis Womens health: Menopause, Pre-Menstrual Syndrome, pregnancy Respiratory health: Asthma, Bronchitis, Chronic Obstructive Pulmonary Disease (COPD) Gastrointestinal health: Irritable Bowel Syndrome (IBS), Pancreatitis

73 The Cochrane Library. Cochrane Database of Systematic Reviews. http://www.mrw.interscience.wiley.com/cochrane/cochrane_clsysrev_articles_fs.html. Accessed 15/1/08.

2. Review of the literature

Cognitive function/neurological conditions: Pain management, headaches and migraine, motor skills, cognitive function, Carpal Tunnel Syndrome, Multiple Sclerosis, Attention Deficit Hyperactivity Disorder (ADHD) Cancer care: Cancer-related symptoms and quality of life Seniors and carers: Palliative care, carer health, dementia and quality of life in geriatric care

Condition-specific keywords and phrases were used to filter searches and are shown in the following sections. Studies prior to 1985 were not included in these results and except where particularly relevant, non-English studies have also been excluded.

Due to the large number of studies found relating to Mindfulness Based Stress Reduction (MBSR), which is a specific application of a meditative technique and usually not practised in the context of yoga, MBSR studies are not reported here, unless the intervention blended MBSR with other aspects of yoga or meditation. For the same reasons, only the most relevant of many studies into the benefits of Transcendental Meditation (TM) have been included.

2. Review of the literature

2.6. Cardiovascular health

The benefits of yoga and yoga ‘lifestyle’ interventions on cardiovascular health have been confirmed in a number of systematic reviews. A summary of some of the most relevant research follows.

2.6.1. Yoga lifestyle intervention The popular book, ‘Dr Dean Ornish’s Program for Reversing Heart Disease,74’ describes a one year study, first published in The Lancet in 199075, and the five year follow-up study, published in the Journal of the American Medical Association in 199876. Ornish’s program includes yoga as part of a comprehensive program of lifestyle change, including nutrition (less than 10% fat, whole foods, vegetarian diet, vitamins and supplements), exercise (moderate regular aerobic exercise), stress management techniques (stretching, breathing, meditation, relaxation), smoking cessation and love/intimacy (group psychosocial support and communication).

In the first one year study, 28 patients were assigned to the experimental group and 20 to a usual-care control group. 195 coronary artery lesions were analysed by quantitative angiography. Overall, 82% of the intervention group experienced a regression of average percentage diameter stenosis from 61.1 (8.8%) to 55.8 (11.0%) while lesions progressed in the control group. The authors concluded that, “Comprehensive lifestyle changes may be able to bring about regression of even severe coronary atherosclerosis after only one year, without the use of lipid-lowering drugs.”

Of the initial 28 patients, 20 made and maintained comprehensive lifestyle changes for five years and completed the follow-up quantitative coronary arteriography. The experimental group experienced 25 cardiac events and a 4.5% relative improvement in average percent diameter stenosis after one year, and 7.9% after five years. The 20 control group patients experienced 45 cardiac events and a 5.4% relative worsening after 1 year, and 27.7% relative worsening after five years.

It is important to note that the Ornish studies utilised ‘yoga lifesyle’ as an intervention, as distinct from yoga postures. Ornish was himself a disciple of Swami Satchitananda (Integral yoga) and was no doubt influenced in the design of the intervention by his knowledge of yoga ashram life.

Interestingly, in his book, Ornish describes his decision back in 1977, on advice from a prominent cardiologist, not to describe his proposed research as “Effects of Yoga and a Vegetarian Diet on Coronary Heart Disease”, due to possible association by the medical community of the word yoga with the sixties counterculture and, “images of yogis in orange robes with shaved heads.77” At the time, meditation also was seen as synonymous with Transcendental Meditation (TM) made popular by Maharishi Mahesh Yogi78 and therefore, potentially tainted in the eyes of the scientific community.

74 Ornish D. Dr. Dean Ornish’s Program for Reversing Heart Disease. Ballantine Books 1996. 75 Ornish D, Brown SE, Scherwitz LW, Billings JH, Armstrong WT, Ports TA, McLanahan SM, Kirkeeide RL, Brand RJ, Gould KL. Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. Lancet 1990; 336(8708):129-33. 76 Ornish D, Scherwitz LW, Billings JH, Brown SE, Gould KL, Merritt TA, Sparler S, Armstrong WT, Ports TA, Kirkeeide RL, Hogeboom C, Brand RJ. Intensive lifestyle changes for reversal of coronary heart disease. JAMA 1998; 280(23):2001-7. 77 Ornish D. Dr. Dean Ornish’s Program for Reversing Heart Disease. Ballantine Books 1996. p132. 78 The Transcendental Meditation Program. http://www.tm.org/. Accessed 10/1/08.

2. Review of the literature

As a result, to this day, some reviewers and researchers fail to include this research in literature reviews of yoga for the prevention, management and treatment of CVD79. Yet in Ornish’s words, “almost all of these techniques ultimately derive from yoga.80”

2.6.2. Summary of the evidence Illustrating the difference between ‘yoga’ and ‘yoga lifestyle’, a systematic review of yoga for cardiovascular disease in 2004 found 13 suitable studies, six of which were RCTs, concluding that an hour a day of yoga was beneficial for hypertension, obesity, hyperlipidaemia, glycaemic control for diabetes, and improved quality of life post myocardial infarction (MI). However, the reviewer found no studies to show a benefit from yoga on ischaemic heart disease itself81.

More recently, a systematic review of the effects of yoga on cardiovascular disease82, found 70 studies that met the inclusion criteria. Beneficial changes were indicated in several insulin resistance syndrome (IRS) related indices of CVD risk, including glucose tolerance and insulin sensitivity, lipid profiles, blood pressure, oxidative stress, coagulation profiles, sympathetic activation, and cardiovagal function, as well as improvement in several clinical endpoints. The authors concluded, “collectively, these studies suggest that yoga may reduce many IRS- related risk factors for CVD, may improve clinical outcomes, and may aid in the management of CVD and other IRS-related conditions.” However, the studies in the review were seen to have methodologcal and other limitations, which limited drawing firm conclusions.

Finally, a review published in 200483 found that meditation, imagery, and yoga were the most commonly used CAM techniques, used by 20% of those with chronic pain and 13% of those with insomnia, “conditions for which consensus panels have concluded that mind-body therapies are effective.” However, the authors concluded, “they were also used by less than 20% of those with heart disease, headaches, back or neck pain, and cancer, conditions for which there is strong research support.”

As mentioned earlier, yoga and meditation are holistic disciplines, and perhaps best able to exert influence on a medical condition by nurturing and supporting the patient’s healing. By way of example, in a US study84, 72 first-time cardiac rehabilitation patients completed questionnaires before and after participating in a weekend retreat. The retreat included education and discussion on lifestyle, exercise, nutrition, stress management techniques, communication techniques that enhance social support, and spiritual principals of healing. Experiential practices included yoga, meditation, visualisation, and prayer. Three quarters (78%) of the participants reported increased spirituality after the retreat, associated with a sense of well-being, meaning in life, confidence in handling problems and decreased tendancy to become angry. The researchers recommended the development of healthcare settings that can support this level of integration.

79 Mansberg G. More than just posturing. Medical Observer Weekly. http://www.medicalobserver.com.au/displayarticle/index.asp?articleID=5911&templateID=108§ionID=0§ionName. Accessed 10/1/08. 80 Ornish D. Dr. Dean Ornish’s Program for Reversing Heart Disease. Ballantine Books 1996. p132. 81 Jayasinghe SR. Yoga in cardiac health (a review). Eur J Cardiovasc Prev Rehabil. 2004 Oct;11(5):369-75. 82 Innes KE, Bourguignon C, Taylor AG. Risk indices associated with the insulin resistance syndrome, cardiovascular disease, and possible protection with yoga: a systematic review. J Am Board Fam Pract. 2005; 18:491-519. 83 Wolsko PM, Eisenberg DM, Davis RB, Phillips RS. Use of mind-body medical therapies. J Gen Intern Med 2004; 19(1):43-50. 84 Kennedy JE, Abbott RA, Rosenberg BS. Changes in spirituality and well-being in a retreat program for cardiac patients. Alt Ther Health Med 2002; 8(4):64-6:68-70;72-3.

2. Review of the literature

Table 2.6.1 below summarises the results of significant studies in cardiovascular health.

Search terms: coronary artery, heart disease, cardiovascular, blood pressure, hypertension, lipid, cholesterol, metabolic syndrome, IRS, insulin resist*, diabet*, NIDDM, glucose, obesity, weight.

Table 2.6.1. Yoga and meditation for Cardiovascular Disease, Hypertension, Dislipidemia, Metabolic (Insulin Resistance) Syndrome, Diabetes and weight management

Study details Summary N= Effect Innes 200785 A review found that yoga and other traditional mind-body therapies may offer n/a 1+ Review USA particular promise in both the primary and secondary prevention of cardiovascular disease by addressing inter-related psychological and physiological components of health. Innes 200586 A systematic review of the effects of yoga on cardiovascular disease (CVD) found n/a 2+ Systematic 70 eligible studies including 26 uncontrolled trials, 21 non-RCTs, and 22 RCTs. review USA Collectively, the studies found yoga beneficial for several insulin resistance syndrome related indices of CVD risk, including glucose tolerance and insulin sensitivity, lipid profiles, anthropometric characteristics, blood pressure, oxidative stress, coagulation profiles, sympathetic activation, and cardiovagal function, as well as improvement in several clinical endpoints. Arthur 200687 A systematic review found some evidence for Tai Chi and Transcendental n/a 1+ Systematic Meditation as adjunct therapies in cardiac rehabilitation or secondary prevention. review Canada Canter 200488 A review of Transcendental Meditation (TM) for hypertension found six trials that n/a +/- Systematic met the inclusion criteria, however the reviewers found the trials procedurally review UK inadequate, potentially biased and only one of the trials tested the effect of TM in hypertensive individuals. Hutchinson A systematic review of six RCTs suggested that yoga can normalise cardiovascular n/a 1+ 200489 risk factors and be a supportive therapy for coronary heart disease. Systematic review Jayasinghe A review of yoga for cardiovascular disease found 13 suitable studies, six of which n/a 1+ 200490 were RCTs, concluding that an hour a day of yoga was beneficial for Systematic hypertension, while having significant benefits on obesity, hyperlipidaemia, review USA glycaemic control for diabetes, and improved quality of life post myocardial infarction. However, the reviewer found no studies to show a benefit from yoga on ischaemic heart disease itself. Canter 200391 A review found one trial in which three months practice of Transcendental n/a +/- Systematic Meditation (TM) significantly reduced diastolic and systolic blood pressure. review UK Progressive muscle relaxation produced an intermediate effect size. Any benefit of TM for asthma, exercise tolerance in cardiovascular disease, or atherosclerosis was unclear. Overall, evidence for any type of meditation is weak and where effective, may be due to stress reduction. Meditation may trigger psychotic episodes in seriously disturbed patients.

85 Innes KE, Vincent HK, Taylor AG. Chronic stress and insulin resistance-related indices of cardiovascular disease risk, part 2: a potential role for mind-body therapies. Altern Ther Health Med. 2007 Sep-Oct;13(5):44-51. Erratum in: Altern Ther Health Med. 2007 Nov-Dec;13(6):15. 86 Innes KE, Bourguignon C, Taylor AG. Risk indices associated with the insulin resistance syndrome, cardiovascular disease, and possible protection with yoga: a SR. J Am Board Fam Pract. 2005 Nov-Dec;18(6):491-519. 87 Arthur HM, Patterson C, Stone JA. The role of complementary and alternative therapies in cardiac rehabilitation: a systematic evaluation. Eur J Cardiovasc Prev Rehabil. 2006 Feb;13(1):3-9. 88 Canter PH, Ernst E. Insufficient evidence to conclude whether or not Transcendental Meditation decreases blood pressure: results of a systematic review of randomised clinical trials. J Hypertens. 2004 Nov;22(11):2049-54. 89 Hutchinson S, Ernst E. Yoga therapy for coronary heart disease: a systematic review. Perfusion 2004;17:44–51. 90 Jayasinghe SR. Yoga in cardiac health (a Review). Eur J Cardiovasc Prev Rehabil. 2004 Oct;11(5):369-75. Review. 91 Canter PH. The therapuetic effects of meditation. BMJ 2003;326:1049-1050 (17 May), doi:10.1136/bmj.326.7398.1049.

2. Review of the literature

Table 2.6.1. (continued)

Study details Summary N= Effect Astin 200392 A review found considerable evidence of efficacy for meditation, relaxation and n/a 2+ Systematic other mind-body therapies as adjuncts in the treatment of coronary artery disease review USA (eg, cardiac rehabilitation), headaches, insomnia, incontinence, chronic low back pain, disease and treatment-related symptoms of cancer, and improving postsurgical outcomes. There was moderate evidence only of efficacy for mind- body therapies in the areas of hypertension and arthritis. Ernst 200593 A review found the most encouraging complementary therapies for hypertension n/a 1+ Review were garlic, autogenic training, biofeedback and yoga. Germany Kreitzer 200294 A review found promising therapies to integrate in treatment of stress, anxiety, n/a 1+ Review USA and lifestyle patterns known to contribute to cardiovascular disease, included imagery and hypnosis, meditation, yoga, tai chi, prayer, music, exercise, diet, and use of dietary supplements. Luskin 199895 A review of mind/body practices including cognitive-behavioral therapy, n/a 1+ Review USA meditation, imagery, visualisation, spiritual/energy healing, music therapy, hypnosis, yoga, tai chi, and qi gong found some evidence of efficacy primarily as complementary and sometimes as stand-alone alternative treatments for cardiovascular disease-related conditions. Sharpe 200796 A national survey in the US found the most often used therapies for weight n/a 1+ MS USA control were yoga (57.4%), meditation (8.2%), acupuncture (7.7%), massage (7.5%), and Eastern martial arts (5.9%). Granath A stress management program based on cognitive behavioural therapy was 33 1+ 200697 RCT compared with a Kundalini yoga program in 10 sessions over four months. Self- Sweden rated stress, anger, exhaustion, quality of life, blood pressure, heart rate, urinary catecholamines and salivary cortisol measures improved significantly in both groups with no significant difference between groups. Paul-Labrador Transcendental meditation (TM) was compared to health education for 103 1+ 200698 RCT components of metabolic syndrome in stable coronary heart disease patients over USA 16 weeks. The TM group had beneficial changes in systolic blood pressure, insulin resistance and heart rate variability. There was no effect in brachial artery reactivity testing. Edelman A personalised intervention program comprising techniques such as mindfulness 154 1+ 200699 RCT meditation, relaxation training, stress management, motivational techniques, USA health education and coaching over 10 months was compared to control in outpatients with cardiovascular disease risk factors. Exercise levels and weight loss increased in the intervention group and CVD risk decreased significantly.

92 Astin JA, Shapiro SL, Eisenberg DM, Forys KL. Mind-body medicine: state of the science, implications for practice. J Am Board Fam Pract. 2003 Mar-Apr;16(2):131-47. 93 Ernst E. Complementary/alternative medicine for hypertension: a mini-review. Wien Med Wochenschr. 2005 Sep;155(17- 18):386-91. 94 Kreitzer MJ, Snyder M. Healing the heart: integrating complementary therapies and healing practices into the care of cardiovascular patients. Prog Cardiovasc Nurs. 2002 Spring;17(2):73-80. 95 Luskin FM, Newell KA, Griffith M, Holmes M, Telles S, Marvasti FF, Pelletier KR, Haskell WL. A review of mind-body therapies in the treatment of cardiovascular disease. Part 1: Implications for the elderly. Altern Ther Health Med. 1998 May;4(3):46-61. 96 Sharpe PA, Blanck HM, Williams JE, Ainsworth BE, Conway JM. Use of complementary and alternative medicine for weight control in the United States. J Altern Complement Med. 2007 Mar;13(2):217-22. 97 Granath J, Ingvarsson S, von Thiele U, Lundberg U. Stress management: a randomised study of cognitive behavioural therapy and yoga. Cogn Behav Ther. 2006;35(1):3-10. 98 Paul-Labrador M, Polk D, Dwyer JH, Velasquez I, Nidich S, Rainforth M, Schneider R, Merz CN. Effects of a RCT of transcendental meditation on components of the metabolic syndrome in subjects with coronary heart disease. Arch Intern Med. 2006 Jun 12;166(11):1218-24. 99 Edelman D, Oddone EZ, Liebowitz RS, Yancy WS Jr, Olsen MK, Jeffreys AS, Moon SD, Harris AC, Smith LL, Quillian-Wolever RE, Gaudet TW. A multidimensional integrative medicine intervention to improve cardiovascular risk. J Gen Intern Med. 2006 Jul;21(7):728-34.

2. Review of the literature

Table 2.6.1. (continued)

Study details Summary N= Effect McCaffrey A yoga intervention for a group of hypertensive patients resulted in significantly n/a 1+ 2005100 RCT decreased mean stress scores and blood pressure, heart rate, and body mass USA index levels. Schneider The effect of Transcendental Meditation (TM) or progressive muscle relaxation 150 1+ 2005101 RCT (PMR) for 20 minutes twice a day or participation in conventional health education USA classes was investigated for a period of one year. The TM group showed the greatest decrease in systolic and diastolic blood pressure between groups and reduced use of antihypertensive medication compared to increases for the PMR and health education groups. Barnes 2004102 A program of 10 minute sessions of meditation at school and at home each day 73 1+ RCT USA for three months resulted in significant improvements in resting and ambulatory systolic, ambulatory diastolic blood pressure and heart rate in healthy youth. Barnes 2004103 A four month program of Transcendental Meditation (TM) was found to reduce 100 1+ RCT USA ambulatory blood pressure in adolescents compared to health education control. Harinath A group of healthy men practised yoga morning and evening daily (60 minutes of 30 1+ 2004104 RCT postures, 15 minutes of pranayama and 30 minutes of meditation) for three India months, resulting in an improvement in cardiorespiratory performance (systolic blood pressure, diastolic blood pressure, mean arterial pressure and orthostatic tolerance) and psychological profile. Plasma melatonin also increased. Singh 2004105 Forty days of yoga practice for 30-40 minutes a day decreased fasting and post- 24 1+ Clinical trial prandial blood glucose and glycosylated hemoglobin in Type 2 diabetics. Pulse India rate, systolic and diastolic blood pressure also decreased significantly over control. Walton 2004106 Women who were long term Transcendental Meditation (TM) practitioners were 30 1+ Clinical trial found to have lower cortisol response to metabolic challenge possibly via USA improved endocrine regulation. The number of months practising TM was inversely correlated with heart disease risk factors. Yogendra A yoga program plus control of risk factors, dietary modifications and stress 113 1+ 2004107 Clinical management for a period of one year resulted in significant reduction in total trial India cholesterol, LDL cholesterol, regression of disease on angiography, arrest of progression and anxiety scores.

100 McCaffrey R, Ruknui P, Hatthakit U, Kasetsomboon P. The effects of yoga on hypertensive persons in Thailand. Holist Nurs Pract. 2005 Jul-Aug;19(4):173-80. 101 Schneider RH, Alexander CN, Staggers F, Orme-Johnson DW, Rainforth M, Salerno JW, Sheppard W, Castillo-Richmond A, Barnes VA, Nidich SI. A RCT of stress reduction in African Americans treated for hypertension for over one year. Am J Hypertens. 2005 Jan;18(1):88-98. 102 Barnes VA, Davis HC, Murzynowski JB, Treiber FA. Impact of meditation on resting and ambulatory blood pressure and heart rate in youth. Psychosom Med. 2004 Nov-Dec;66(6):909-14. 103 Barnes VA, Treiber FA, Johnson MH. Impact of transcendental meditation on ambulatory blood pressure in African-American adolescents. Am J Hypertens. 2004 Apr;17(4):366-9. 104 Harinath K, Malhotra AS, Pal K, Prasad R, Kumar R, Kain TC, Rai L, Sawhney RC. Effects of Hatha yoga and Omkar meditation on cardiorespiratory performance, psychologic profile, and melatonin secretion. J Altern Complement Med. 2004 Apr;10(2):261-8. 105 Singh S, Malhotra V, Singh KP, Madhu SV, Tandon OP. Role of yoga in modifying certain cardiovascular functions in type 2 diabetic patients. J Assoc Physicians India. 2004 Mar;52:203-6. 106 Walton KG, Fields JZ, Levitsky DK, Harris DA, Pugh ND, Schneider RH. Lowering cortisol and CVD risk in postmenopausal women: a pilot study using the Transcendental Meditation program. Ann N Y Acad Sci. 2004 Dec;1032:211-5. 107 Yogendra J, Yogendra HJ, Ambardekar S, Lele RD, Shetty S, Dave M, Husein N. Beneficial effects of yoga lifestyle on reversibility of ischaemic heart disease: caring heart project of International Board of Yoga. J Assoc Physicians India. 2004 Apr;52:283-9.

2. Review of the literature

Table 2.6.1. (continued)

Study details Summary N= Effect Jatuporn The effect of an intensive lifestyle modification program (dietary advice on low-fat 22 1+ 2003108 RCT diets, high antioxidants and high fiber intake, yoga exercise, stress management Thailand and smoking cessation) for four months on lipid peroxidation and antioxidant systems was investigated in patients with coronary artery disease. The lifestyle program resulted in a significant increase in plasma antioxidants, plasma vitamin E and erythrocyte glutathione (GSH) compared to control. There was no significant change in plasma malondialdehyde (MDA), a circulating product of lipid peroxidation in either group. Damodaran One hour of daily yoga practice for three months was shown to decrease blood 20 1+ 2002109 Clinical pressure and drug score, blood glucose, cholesterol and triglycerides, while trial India subjective well-being and quality of life improved. Malhotra A sequence of yoga postures practised for 30-40 minutes a day for 40 days 24 1+ 2002110 Clinical resulted in a significant decrease in fasting blood glucose levels. Post-prandial trial India blood glucose levels and glycosylated hemoglobin also decreased while some measures of pulmonary function increased. Manchanda A program of yoga, control of risk factors, diet control and moderate aerobic 42 1+ 2000111 RCT exercise 90 minutes a day for a year was compared to risk factor control and diet India education. Coronary angiography found significantly more lesions regressed, and less lesions progressed in the yoga group. The yoga group also experienced improved symptomatic status, functional class and risk factor profile. Murugesan A program of one hour of yoga a day for 11 weeks and usual treatment control 33 1+ 2000112 RCT were both found to be effective in controlling the variables of hypertension India (systolic and diastolic blood pressure, pulse rate and body weight). Castillo- A program of Transcendental Meditation (TM) resulted in a significant reduction in 60 1+ Richmond carotid atherosclerosis compared with health education in African Americans. 2000113 RCT USA Mahajan The effect of four days training in yoga followed by practice at home for 14 weeks 93 1+ 1999114 RCT plus yogic lifestyle advice was compared to lifestyle advice only in subjects with India risk factors of coronary artery disease. The subjects practising yoga showed a regular decrease in all lipid parameters except HDL cholesterol. The effect started from four weeks and lasted for 14 weeks.

108 Jatuporn S, Sangwatanaroj S, Saengsiri AO, Rattanapruks S, Srimahachota S, Uthayachalerm W, Kuanoon W, Panpakdee O, Tangkijvanich P, Tosukhowong P. Short-term effects of an intensive lifestyle modification program on lipid peroxidation and antioxidant systems in patients with coronary artery disease. Clin Hemorheol Microcirc. 2003;29(3-4):429-36. 109 Damodaran A, Malathi A, Patil N, Shah N, Suryavansihi, Marathe S. Therapeutic potential of yoga practices in modifying cardiovascular risk profile in middle aged men and women. J Assoc Physicians India. 2002 May;50(5):633-40. 110 Malhotra V, Singh S, Singh KP, Gupta P, Sharma SB, Madhu SV, Tandon OP. Study of yoga asanas in assessment of pulmonary function in NIDDM patients. Indian J Physiol Pharmacol. 2002 Jul;46(3):313-20. 111 Manchanda SC, Narang R, Reddy KS, Sachdeva U, Prabhakaran D, Dharmanand S, Rajani M, Bijlani R. Retardation of coronary atherosclerosis with yoga lifestyle intervention. J Assoc Physicians India. 2000 Jul;48(7):687-94. 112 Murugesan R, Govindarajulu N, Bera TK. Effect of selected yogic practices on the management of hypertension. Indian J Physiol Pharmacol. 2000 Apr;44(2):207-10. 113 Castillo-Richmond A, Schneider RH, Alexander CN, Cook R, Myers H, Nidich S, Haney C, Rainforth M, Salerno J. Effects of stress reduction on carotid atherosclerosis in hypertensive African Americans. Stroke. 2000 Mar;31(3):568-73. 114 Mahajan AS, Reddy KS, Sachdeva U. Lipid profile of coronary risk subjects following yogic lifestyle intervention. Indian Heart J. 1999 Jan-Feb;51(1):37-40.

2. Review of the literature

Table 2.6.1. (continued)

Study details Summary N= Effect Rutledge A two year independent-living lifestyle modification program for patients with 71 1+ 1999115 Clinical coronary artery disease utilised a multi-disciplinary support team, several weekly trial USA sessions for exercise, meditation/stress reduction training, dietary education and counseling, participatory dinners, emphasis on self care and regular monitoring and feedback. Results included a significant reduction in body weight, dietary intake of saturated fat and cholesterol, low and high-density lipoprotein concentration, and an increase in exercise capacity. Compliance in self-regulated lifestyle change programs was identified as an important issue. Ornish 1998116 Yoga as part of a comprehensive program of lifestyle change, including nutrition, 40 1+ RCT USA exercise, stress management, smoking cessation and love/intimacy was followed up over 5 years in patients with coronary artery disease. The yoga group experienced significantly less cardiac events and further improvement in average percent diameter stenosis while the control group experienced further worsening of coronary artery lesions. Schmidt A comprehensive residential three-month kriya yoga training, meditation and n/a 1+ 1997117 Clinical vegetarian nutrition program reported substantial cardiovascular risk factor trial Germany reduction including body mass index, total serum and LDL cholesterol, fibrinogen, and blood pressure. Wenneberg Transcendental Meditation (TM) was compared to a cognitive-based stress 39 1+ 1997118 RCT education control for four months. Both groups recorded no change in USA cardiovascular response to stressors, however the subjects regularly practising TM demonstrated a significant reduction in average ambulatory diastolic blood pressure. Zamarra The effect of Transcendental Meditation (TM) on patients with coronary artery 21 1+ 1996119 Clinical disease over eight months included an increase in exercise tolerance and maximal trial USA workload, and improvement in other ECG measures over control. Schneider A program of Transcendental Meditation (TM) over three months reduced systolic 127 1+ 1995120 RCT and diastolic blood pressure significantly more than progressive muscle relaxation USA or lifestyle modification education control. Ornish 1990121 Yoga as part of a comprehensive program of lifestyle change, including nutrition, 48 1+ RCT USA exercise, stress management, smoking cessation and love/intimacy was evaluated over 12 months in patients with coronary artery disease. Overall, 82% of the intervention group experienced a regression of coronary artery lesions measured by angiography while lesions progressed in the control group.

115 Rutledge JC, Hyson DA, Garduno D, Cort DA, Paumer L, Kappagoda CT. Lifestyle modification program in management of patients with coronary artery disease: the clinical experience in a tertiary care hospital. J Cardiopulm Rehabil. 1999 Jul- Aug;19(4):226-34. 116 Ornish D, Scherwitz LW, Billings JH, Brown SE, Gould KL, Merritt TA, Sparler S, Armstrong WT, Ports TA, Kirkeeide RL, Hogeboom C, Brand RJ. Intensive lifestyle changes for reversal of coronary heart disease. JAMA. 1998 Dec 16;280(23):2001-7. Erratum in: JAMA 1999 Apr 21;281(15):1380. 117 Schmidt T, Wijga A, Von Zur Mühlen A, Brabant G, Wagner TO. Changes in cardiovascular risk factors and hormones during a comprehensive residential three month kriya yoga training and vegetarian nutrition. Acta Physiol Scand Suppl. 1997;640:158- 62. 118 Wenneberg SR, Schneider RH, Walton KG, Maclean CR, Levitsky DK, Salerno JW, Wallace RK, Mandarino JV, Rainforth MV, Waziri R. A controlled study of the effects of the Transcendental Meditation program on cardiovascular reactivity and ambulatory blood pressure. Int J Neurosci. 1997 Jan;89(1-2):15-28. 119 Zamarra JW, Schneider RH, Besseghini I, Robinson DK, Salerno JW. Usefulness of the transcendental meditation program in the treatment of patients with coronary artery disease. Am J Cardiol. 1996 Apr 15;77(10):867-70. 120 Schneider RH, Staggers F, Alxander CN, Sheppard W, Rainforth M, Kondwani K, Smith S, King CG. A RCT of stress reduction for hypertension in older African Americans. Hypertension. 1995 Nov;26(5):820-7. 121 Ornish D, Brown SE, Scherwitz LW, Billings JH, Armstrong WT, Ports TA, McLanahan SM, Kirkeeide RL, Brand RJ, Gould KL. Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. Lancet. 1990 Jul 21;336(8708):129-33.

2. Review of the literature

Table 2.6.1. (continued)

Study details Summary N= Effect Van Montfrans An intervention comprising training in muscle relaxation, yoga exercises and 35 1- 1990122 RCT stress management one hour a week for eight weeks followed by a year of twice Netherlands daily home practice and monthly clinic visits was compared to a no relaxation training control. Systolic and diastolic blood pressure was marginally lower in the intervention group after one year and other results showed no benefit. Patel 1985123 Relaxation plus health education was compared to education alone in participants 192 1+ RCT having two or more risk factors of high blood pressure, high cholesterol or smoker. After eight weeks and eight months there was a significant difference in systolic and diastolic blood pressure between the groups, which was maintained after four years. Cholesterol and number of cigarettes smoked were lower in the relaxation group at eight weeks and eight months but not at four years. There was more angina, heart disease, fatal cardiac events and treatment for hypertension and its complications in the control group.

122 Van Montfrans GA, Karemaker JM, Wieling W, Dunning AJ. Relaxation therapy and continuous ambulatory blood pressure in mild hypertension: BMJ. 1990 May 26;300(6736):1368-72. 123 Patel C, Marmot MG, Terry DJ, Carruthers M, Hunt B, Patel M. Trial of relaxation in reducing coronary risk: four year follow up. Br Med J (Clin Res Ed). 1985 Apr 13;290(6475):1103-6.

2. Review of the literature

2.7. Mental health

2.7.1. The concept of Adhi Over 60 years ago, the World Health Organisation (WHO) created a forward-thinking definition of health, as "A state of complete physical, mental, social and spiritual well-being, and not merely an absence of disease or infirmity124."

Mental health encompasses a broad range of conditions. At one end of the spectrum there are emotional or mental disturbances, sometimes manifesting as anxiety disorders (eg; chronic anxiety, stress and panic attacks), eating disorders, addictions, sleeping disorders, behavioural disorders (eg; OCD). At the other end of the spectrum are depression, bi-polar and other major mood and personality disorders.

Quoting the Mental Health Foundation of Australia: "One in five of us will experience depression at some time in our life. Unfortunately, only about 20% of depressed people are correctly diagnosed because depression can mask itself as physical illness (such as chronic pain, anxiety, sleeplessness or fatigue). Depression can contribute to, and be caused by, many physical illnesses. The World Health Organisation has concluded that by 2020, depression will be the world's major health problem125."

In yoga, mental disturbance is recognised as the ‘Adhi’ that first exists in the manomaya kosa (the mental/emotional personality), eventually filtering through to the annamaya kosa (the physical body), and manifesting as somatic illness126. Adhi is characterised by excessive speed, mental restlessness and emotional disruption (stress, anxiety, anger and resentment), often seen as products of modern life.

2.7.2. Summary of the evidence There is growing evidence in the literature supporting the use of yoga and meditation related interventions for mental heath issues such as stress, anxiety disorders and depression; primarily as adjunct therapies to conventional treatment or as part of a multi-disciplinary approach, and occasionally as stand-alone approaches.

An Australian systematic review of the effectiveness of complementary and self-help treatments for anxiety disorders found one non-randomised study which showed that yoga was superior to diazepam for generalised anxiety. Another randomised trial reported yoga plus autosuggestion, progressive muscle relaxation or a control talking session was superior on one outcome measure, but not on another. The reviewers found the evidence for yoga interventions on anxiety was inconclusive127,128.

124 World Health Organisation (1946). WHO definition of health. http://www.who.int/suggestions/faq/en/. Accessed 9/2/08. 125 Mental Health Foundation of Australia. http://www.mhfa.org.au/main.htm. Accessed 15/7/04. 126 Nagarathna, R, Nagendra, HR. Integrated Approach of Yoga Therapy for Positive Health. Swami Vivekananda Yoga Prakashana, 2001. 127 Janakiramaiah N, Gangadhar BN, Naga Venkatesha Murthy PJ, Harish MG, Subbakrishna DK, Vedamurthachar A. Antidepressant efficacy of Sudarshan Kriya Yoga (SKY) in melancholia: a randomised comparison with electroconvulsive therapy (ECT) and imipramine. J Affect Disord. 2000 Jan-Mar;57(1-3):255-9. 128 Jorm AF, Christensen H, Griffiths KM, Rodgers B. Effectiveness of complementary and self-help treatments for depression. Med J Aust. 2002 May 20;176 Suppl:S84-96.

2. Review of the literature

The same review found five RCTs that examined the effect of meditation in generalised anxiety disorder or high trait anxiety. Four of the five trials found that meditation produced equivalent effects to other forms of relaxation, including applied relaxation, progressive muscular relaxation, and biofeedback; these effects were superior in comparison to a waitlist control. The reviewers concluded that meditation may be an effective intervention for high trait anxiety and generalised anxiety disorder, but its effectiveness for other forms of anxiety disorder has not been established129.

An American systematic review of the effectiveness of meditation across all medical conditions130 included 20 RCTs comprising 958 subjects, out of 82 possible studies, and found the strongest evidence of efficacy for epilepsy, symptoms of premenstrual syndrome, and menopausal symptoms. Benefit was also demonstrated for nonpsychotic mood and anxiety disorders, autoimmune illness, and emotional disturbance in neoplastic disease. The reviewers concluded, “Meditative techniques are frequently sought by patients coping with medical and psychological problems and this review goes some way to establishing benefit in the conditions listed.”

An Australian systematic review of the use complementary therapies in depression, found limited evidence to support the effectiveness of relaxation therapy and yoga breathing exercises for depression131. Specifically, two RCTs were identified into the use of yogic breathing exercises in depression. One study showed yogic relaxation to be effective in controlling depressive symptoms in university students132 and the second study showed yogic breathing to be as effective as imipramine (a tricyclic antidepressant) in hospitalised patients with melancholic depression133. The reviewers concluded that although that current research into yogic breathing looks promising, further evaluation is required.

Table 2.7.1 summarises the results of significant studies in this field.

Search terms: stress, anxiety, depress*, mood, obsess*, schizo*, psycho*, sleep.

129 Jorm AF, Christensen H, Griffiths K, Parslow R, Rodgers B, Blewitt K. Effectiveness of complementary and self-help treatments for anxiety disorders. MJA 2004; 181 (7 Suppl): S29-S46. 130 Arias AJ, Steinberg K, Banga A, Trestman RL. Systematic review of the efficacy of meditation techniques as treatments for medical illness. J Altern Complement Med. 2006 Oct;12(8):817-32. 131 Jorm AF, Christensen H, Griffiths KM, Rodgers B. Effectiveness of complementary and self-help treatments for depression. Med J Aust. 2002 May 20;176 Suppl:S84-96. 132 Khumar SS, Kaur P, Kaur S. Effectiveness of shavasana on depression among university students. Indian J Clin Psychol 1993; 20: 82-87. 133 Janakiramaiah N, Gangadhar BN, Naga Venkatesha Murthy PJ, Harish MG, Subbakrishna DK, Vedamurthachar A. Antidepressant efficacy of Sudarshan Kriya Yoga (SKY) in melancholia: a randomised comparison with electroconvulsive therapy (ECT) and imipramine. J Affect Disord. 2000 Jan-Mar;57(1-3):255-9.

2. Review of the literature

Table 2.7.1. Yoga and meditation for stress, anxiety, anxiety disorders mood disorders, sleep disorders and depression

Study details Summary N= Effect Arias 2006134 In a review of 82 studies, 20 RCTs comprising 958 subjects met the inclusion 958 2+ Systematic criteria. The strongest evidence for efficacy was found for epilepsy, symptoms review USA of premenstrual syndrome and menopausal symptoms. Benefit was also demonstrated for nonpsychotic mood and anxiety disorders, autoimmune illness, and emotional disturbance in neoplastic disease. Krisanaprakorn A review found only two studies eligible for inclusion. Anti-anxiety drugs were n/a +/- kit 2006135 continued in both. The duration of trials ranged from 12 to 18 weeks. In one Systematic study, Transcendental Meditation (TM) showed a reduction in anxiety review symptoms and electromyography score comparable with electromyography- Thailand biofeedback and relaxation therapy. The other study comparing Kundalini Yoga with Relaxation/Mindfulness Meditation in treating obsessive-compulsive disorders showed no significant difference. Lafferty A review of 27 clinical trials investigating massage or mind-body interventions, n/a 2+ 2006136 found 26 showed significant improvements in symptoms such as anxiety, Systematic emotional distress, comfort, nausea and pain. However, results were often review USA inconsistent across studies and there were variations in methodology, so it was difficult to judge the clinical significance of the results. Kirkwood A review of eight studies found all reported positive results however quality of n/a +/- 2005137 studies was poor and no firm conclusions can be drawn. Results however were Systematic encouraging, particularly in obsessive-compulsive disorder. review UK Pilkington A systematic review of five RCTs found that overall, yoga interventions for n/a 1+ 2005138 depressive disorders were potentially beneficial; however, variations in Systematic interventions and methodological limitations prevented drawing firm review UK conclusions. Astin 2003139 A review found considerable evidence of efficacy for meditation, relaxation and n/a 2+ Systematic other mind-body therapies as adjuncts in the treatment of coronary artery review USA disease (eg, cardiac rehabilitation), headaches, insomnia, incontinence, chronic low back pain, disease and treatment-related symptoms of cancer, and improving postsurgical outcomes. There was moderate evidence only of efficacy for mind-body therapies in the areas of hypertension and arthritis. Jorm 2004140 A review of CAM for anxiety disorders found the treatments with the best n/a 1+ Review evidence of effectiveness were kava, exercise, relaxation training and Australia bibliotherapy. There was limited evidence to support the effectiveness of acupuncture, music, autogenic training and meditation for generalised anxiety.

134 Arias AJ, Steinberg K, Banga A, Trestman RL. Systematic review of the efficacy of meditation techniques as treatments for medical illness. J Altern Complement Med. 2006 Oct;12(8):817-32. 135 Krisanaprakornkit T, Krisanaprakornkit W, Piyavhatkul N, Laopaiboon M. Meditation therapy for anxiety disorders. Cochrane Database Syst Rev. 2006 Jan 25;(1):CD004998. 136 Lafferty WE, Downey L, McCarty RL, Standish LJ, Patrick DL. Evaluating CAM treatment at the end of life: a review of clinical trials for massage and meditation. Complement Ther Med. 2006 Jun;14(2):100-12. Epub 2006 Mar 29. 137 Kirkwood G, Rampes H, Tuffrey V, Richardson J, Pilkington K. Yoga for anxiety: a systematic review of the research evidence. Br J Sports Med. 2005 Dec;39(12):884-91; discussion 891. 138 Pilkington K, Kirkwood G, Rampes H, Richardson J. Yoga for depression: the research evidence. J Affect Disord. 2005 Dec;89(1-3):13-24. Epub 2005 Sep 26. 139 Astin JA, Shapiro SL, Eisenberg DM, Forys KL. Mind-body medicine: state of the science, implications for practice. J Am Board Fam Pract. 2003 Mar-Apr;16(2):131-47. 140 Jorm AF, Christensen H, Griffiths KM, Parslow RA, Rodgers B, Blewitt KA. Effectiveness of complementary and self-help treatments for anxiety disorders. Med J Aust. 2004 Oct 4;181(7 Suppl):S29-46.

2. Review of the literature

Table 2.7.1. (continued)

Study details Summary N= Effect Jorm 2002141 A systematic review found some limited evidence to support the effectiveness n/a 1+ Systematic of relaxation therapy and yoga breathing exercises for depression. review Australia Eppley 1989142 Progressive relaxation, biofeedback and various forms of meditation were n/a 1+ Review compared for effect sizes on trait anxiety. Transcendental Meditation (TM) had a significantly larger effect size and meditation that involved concentration had a significantly smaller effect. Duration and hours of treatment also significantly influenced effect sizes. Duraiswamy A program of yoga therapy was compared to physical exercise therapy over 41 1+ 2007143 RCT four months in moderately ill schizophrenia patients. Subjects in the yoga group India had significantly less psychopathology and significantly better social and occupational functioning and quality of life. John 2007144 A three-month program of yoga therapy resulted in a significant reduction in 72 1+ RCT India headache intensity, pain and affective pain indices, anxiety and depression scores and medication use. Lane 2007145 Brief instruction in a simple mantra-based meditation technique practised for 133 1+ Clinical trial 15-20 minutes twice daily resulted in significant improvements in measures of USA mood, perceived stress and anxiety and symptoms in healthy adults. More practice was associated with more improvement. Lee 2007146 An eight-week meditation-based stress management program resulted in n/a 1+ RCT South significant improvement in some measures of anxiety, depression, hostility and Korea symptoms. Mitchell Cognitive dissonance and yoga programs did not show significant differences 93 1- 2007147 RCT post-intervention; however, participants in the dissonance program had USA significantly lower scores on measures of disordered eating, drive for thinness, body dissatisfaction and anxiety. Streeter Brain gamma-aminobutyric (GABA) levels, sometimes low in depression and 19 1+ 2007148 Clinical anxiety disorders, were shown to increase by 27% after a single acute one- trial USA hour yoga session. Tang 2007149 An integrated meditation program practised 20 minutes a day for 5 days 40 1+ RCT China resulted in improved measures of conflict, anxiety, depression, anger, fatigue, cortisol and immunoreactivity.

141 Jorm AF, Christensen H, Griffiths KM, Rodgers B. Effectiveness of complementary and self-help treatments for depression. Med J Aust. 2002 May 20;176 Suppl:S84-96. 142 Eppley KR, Abrams AI, Shear J. Differential effects of relaxation techniques on trait anxiety: a meta-analysis. J Clin Psychol. 1989 Nov;45(6):957-74. 143 Duraiswamy G, Thirthalli J, Nagendra HR, Gangadhar BN. Yoga therapy as an add-on treatment in the management of patients with schizophrenia--a RCT. Acta Psychiatr Scand. 2007 Sep;116(3):226-32. 144 John PJ, Sharma N, Sharma CM, Kankane A. Effectiveness of yoga therapy in the treatment of migraine without aura: a RCT. Headache. 2007 May;47(5):654-61. 145 Lane JD, Seskevich JE, Pieper CF. Brief meditation training can improve perceived stress and negative mood. Altern Ther Health Med. 2007 Jan-Feb;13(1):38-44. 146 Lee SH, Ahn SC, Lee YJ, Choi TK, Yook KH, Suh SY. Effectiveness of a meditation-based stress management program as an adjunct to pharmacotherapy in patients with anxiety disorder. J Psychosom Res. 2007 Feb;62(2):189-95. 147 Mitchell KS, Mazzeo SE, Rausch SM, Cooke KL. Innovative interventions for disordered eating: evaluating dissonance-based and yoga interventions. Int J Eat Disord. 2007 Mar;40(2):120-8. 148 Streeter CC, Jensen JE, Perlmutter RM, Cabral HJ, Tian H, Terhune DB, Ciraulo DA, Renshaw PF. Yoga Asana sessions increase brain GABA levels: a pilot study. J Altern Complement Med. 2007 May;13(4):419-26. 149 Tang YY, Ma Y, Wang J, Fan Y, Feng S, Lu Q, Yu Q, Sui D, Rothbart MK, Fan M, Posner MI. Short-term meditation training improves attention and self-regulation. Proc Natl Acad Sci U S A. 2007 Oct 23;104(43):17152-6. Epub 2007 Oct 11.

2. Review of the literature

Table 2.7.1. (continued)

Study details Summary N= Effect Elavsky A four-month program of walking or yoga failed to show significant 164 1- 2007150 RCT improvements in sleep quality in menopausal women. USA Granath A stress management program based on cognitive behavioural therapy was 33 1+ 2006151 RCT compared with a Kundalini yoga program in 10 sessions over four months. Self- Sweden rated stress, anger, exhaustion, quality of life, blood pressure, heart rate, urinary catecholamines and salivary cortisol measures improved significantly in both groups with no significant difference between groups. Sharma Eight weeks of Sahaj (meditative) yoga improved cognitive function in a letter 30 +/- 2006152 RCT cancellation test and a reverse digit span test, but not on other measures. India Smith 2006153 Ten weeks of hatha yoga once a week over six weeks compared to relaxation 131 1+ RCT Australia found mixed results. Yoga was as effective as relaxation at improving stress, anxiety and health status on a number of measures. Yoga was more effective than relaxation in improving mental health. Vedamurthach A program of Sudarshan Kriya Yoga (SKY) breathing exercises practised on 60 1+ ar 2006154 RCT alternate days for two weeks. Depression scores and stress hormones such as India plasma cortisol and ACTH reduced significantly more in the SKY group than control. Michalsen An Iyengar yoga program twice a week for three months resulted in significant 24 1+ 2005155 Clinical improvements in perceived stress, anxiety, well-being, vigour, fatigue and trial Germany depression. Physical well-being also increased and those suffering from headache or back pain reported pain relief. Salivary cortisol also decreased significantly after participation in a yoga class. Sharma A program of eight weeks of Sahaj (meditative) yoga in conjunction with 30 1+ 2005156 RCT conventional anti-depressants in major depression resulted in significant India improvement in measures of depression and anxiety and some remission. Schneider The effect of Transcendental Meditation (TM) or progressive muscle relaxation 150 1+ 2005157 RCT (PMR) for 20 minutes twice a day or participation in conventional health USA education classes was investigated for a period of one year. The TM group showed the greatest decrease in systolic and diastolic blood pressure between groups and reduced use of antihypertensive medication compared to increases for the PMR and health education groups.

150 Elavsky S, McAuley E. Lack of perceived sleep improvement after 4-month structured exercise programs. Menopause. 2007 May-Jun;14(3 Pt 1):535-40. 151 Granath J, Ingvarsson S, von Thiele U, Lundberg U. Stress management: a randomised study of cognitive behavioural therapy and yoga. Cogn Behav Ther. 2006;35(1):3-10. 152 Sharma VK, Das S, Mondal S, Goswami U, Gandhi A. Effect of Sahaj Yoga on neuro-cognitive functions in patients suffering from major depression. Indian J Physiol Pharmacol. 2006 Oct-Dec;50(4):375-83. 153 Smith C, Hancock H, Blake-Mortimer J, Eckert K. A randomised comparative trial of yoga and relaxation to reduce stress and anxiety. Complement Ther Med. 2007 Jun;15(2):77-83. Epub 2006 Jun 21. 154 Vedamurthachar A, Janakiramaiah N, Hegde JM, Shetty TK, Subbakrishna DK, Sureshbabu SV, Gangadhar BN. Antidepressant efficacy and hormonal effects of Sudarshana Kriya Yoga (SKY) in alcohol dependent individuals. J Affect Disord. 2006 Aug;94(1-3):249-53. Epub 2006 Jun 5. 155 Michalsen A, Grossman P, Acil A, Langhorst J, Lüdtke R, Esch T, Stefano GB, Dobos GJ. Rapid stress reduction and anxiolysis among distressed women as a consequence of a three-month intensive yoga program. Med Sci Monit. 2005 Dec;11(12):CR555-561. Epub 2005 Nov 24. 156 Sharma VK, Das S, Mondal S, Goswampi U, Gandhi A. Effect of Sahaj Yoga on depressive disorders. Indian J Physiol Pharmacol. 2005 Oct-Dec;49(4):462-8. 157 Schneider RH, Alexander CN, Staggers F, Orme-Johnson DW, Rainforth M, Salerno JW, Sheppard W, Castillo-Richmond A, Barnes VA, Nidich SI. A RCT of stress reduction in African Americans treated for hypertension for over one year. Am J Hypertens. 2005 Jan;18(1):88-98.

2. Review of the literature

Table 2.7.1. (continued)

Study details Summary N= Effect Ghoncheh The psychological effects of progressive muscle relaxation (PMR) were 40 +/- 2004158 RCT compared to hatha yoga once a week for five weeks. The PMR group displayed USA higher levels of physical relaxation and disengagement at week four and higher levels of mental quiet and joy post-session at week five. The groups were not different on measures of being energised or aware. Woolery A program of Iyengar yoga twice weekly for five weeks comprising postures 28 1+ 2004159 RCT thought to alleviate depression found significant decreases in self-reported USA symptoms of depression and trait anxiety. Subjects also reported decreased levels of negative mood and fatigue following yoga classes. Janakiramaiah A study comparing the relative antidepressant effect of Sudarshan Kriya Yoga 45 1+ 2000160 RCT (SKY) in melancholia with electroconvulsive therapy (ECT) and imipramine over India four weeks found that all three groups achieved similar significant reductions in a measure of depression. At week three, the SKY group had higher scores than the ECT group but was not different from the imipramine group. Remission rates at the end of the trial were 93%, 73%, and 67% respectively. Malathi A yoga program for first year medical students at exam time resulted in 50 1+ 1999161 RCT significantly lower anxiety and reduction in number of failures, and India improvements in self-reported sense of well-being, feeling of relaxation, improved concentration, self confidence, improved efficiency, good interpersonal relationships, increased attentiveness, lowered irritability levels, and optimistic outlook in life. Khasky A program of progressive muscle relaxation (PMR), yoga stretching or imagery 114 1+ 1999162 RCT for 25 minutes was compared. Imagery resulted in lower Negative Affect USA scores. Both yoga stretching and imagery achieved higher self-reported Physical Relaxation, while PMR resulted in lower Somatic Stress scores. Shapiro An eight-week meditation-based stress reduction program for medical students n/a 1+ 1998163 RCT reduced self-reported anxiety and overall psychological distress including USA depression, increased empathy and sense of spiritual experiences. MacLean Practice of Transcendental Meditation (TM) over 4 months had mixed effects on n/a +/- 1997164 RCT stress hormome levels however the authors suggested that practice of TM may USA help reverse the effects of chronic stress significant for health. Smith 1995165 Meditation was added to Fordyce's Personal Happiness Enhancement Program n/a 1+ RCT USA (PHEP) and compared to PHEP alone and control. The meditation plus PHEP group significantly improved on all measures of anxiety, depression and happiness over the other groups.

158 Ghoncheh S, Smith JC. Progressive muscle relaxation, yoga stretching, and ABC relaxation theory. J Clin Psychol. 2004 Jan;60(1):131-6. 159 Woolery A, Myers H, Sternlieb B, Zeltzer L. A yoga intervention for young adults with elevated symptoms of depression. Altern Ther Health Med. 2004 Mar-Apr;10(2):60-3. 160 Janakiramaiah N, Gangadhar BN, Naga Venkatesha Murthy PJ, Harish MG, Subbakrishna DK, Vedamurthachar A. Antidepressant efficacy of Sudarshan Kriya Yoga (SKY) in melancholia: a randomised comparison with electroconvulsive therapy (ECT) and imipramine. J Affect Disord. 2000 Jan-Mar;57(1-3):255-9. 161 Malathi A, Damodaran A. Stress due to exams in medical students--role of yoga. Indian J Physiol Pharmacol. 1999 Apr;43(2):218-24. 162 Khasky AD, Smith JC. Stress, relaxation states, and creativity. Percept Mot Skills. 1999 Apr;88(2):409-16. 163 Shapiro SL, Schwartz GE, Bonner G. Effects of mindfulness-based stress reduction on medical and premedical students. J Behav Med. 1998 Dec;21(6):581-99. 164 MacLean CR, Walton KG, Wenneberg SR, Levitsky DK, Mandarino JP, Waziri R, Hillis SL, Schneider RH. Effects of the Transcendental Meditation program on adaptive mechanisms: changes in hormone levels and responses to stress after 4 months of practice. Psychoneuroendocrinology. 1997 May;22(4):277-95. 165 Smith WP, Compton WC, West WB. Meditation as an adjunct to a happiness enhancement program. J Clin Psychol. 1995 Mar;51(2):269-73.

2. Review of the literature

Table 2.7.1. (continued)

Study details Summary N= Effect Solberg A small RCT in Norway found that six months of meditation may modify the 12 +/- 1995166 RCT suppressive influence of strenous physical stress on the immune system in male Norway runners. Schneider A program of Transcendental Meditation (TM) over 3 months reduced systolic 127 1+ 1995167 RCT and diastolic blood pressure significantly more than progressive muscle USA relaxation or lifestyle modification education control. Schell 1994168 The effect of Hatha yoga practice was compared to a book reading control n/a 1+ Clinical trial group. The yoga group showed markedly higher scores in life satisfaction and Germany lower scores in excitability, aggressiveness, openness, emotionality and somatic complaints. Significant differences were also seen coping with stress and mood. Tloczynski A program of opening-up meditation was compared to relaxation, comprising 45 +/- 1994169 RCT one hour of training followed by 20 minutes practice a day for four weeks. USA Anxiety and family scores increased unfavourably, confounded by high dropout rates leaving few subjects for analysis. Gaylord Transcendental Meditation (TM), Progressive Muscle Relaxation (PMR) and 83 1+ 1989170 RCT cognitive-behavioral strategies were compared in college students. TM and PMR USA improved significantly on measures of overall mental health and anxiety over 12 months. TM showed a greater reduction in neuroticism than PMR. TM also showed global increases in alpha and theta coherence during practice whereas PMR did not show EEG state changes. Rohsenow A program of muscle relaxation and meditation training, cognitive restructuring, n/a 1+ 1985171 RCT and coping skill rehearsal over six months significantly reduced post-treatment daily anxiety ratings and was associated with a reduction in some irrational beliefs. Post-treatment reduction in anxiety and short term drinking rates was not maintained long term. Khalsa 2004172 A simple daily yoga program over eight weeks in a chronic insomnia population 20 1+ Clinical trial resulted in significant improvement in self-reported sleep efficiency, total sleep USA time, total wake time, sleep onset latency and wake time after sleep onset. West 2004173 A single 90-minute session of hatha yoga or african dance achieved significant 69 1+ Clinical trial reductions in perceived stress and negative affect after the session compared USA to control. Wood 1993174 A comparison between relaxation, visualisation or yogic breathing (Pranayama) 71 1+ Clinical trial UK on perceptions of physical and mental energy and on positive and negative mood state, found Pranayama produced a significantly greater increase in perceptions of mental and physical energy and feelings of alertness and enthusiasm than the other two practices.

166 Solberg EE, Halvorsen R, Sundgot-Borgen J, Ingjer F, Holen A. Meditation: a modulator of the immune response to physical stress? A brief report. Br J Sports Med. 1995 Dec;29(4):255-7. 167 Schneider RH, Staggers F, Alxander CN, Sheppard W, Rainforth M, Kondwani K, Smith S, King CG. A RCT of stress reduction for hypertension in older African Americans. Hypertension. 1995 Nov;26(5):820-7. 168 Schell FJ, Allolio B, Schonecke OW. Physiological and psychological effects of Hatha-Yoga exercise in healthy women. Int J Psychosom. 1994;41(1-4):46-52. 169 Tloczynski J. A preliminary study of opening-up meditation college adjustment, and self-actualization. Psychol Rep. 1994 Aug;75(1 Pt 2):449-50. 170 Gaylord C, Orme-Johnson D, Travis F. The effects of the transcendental mediation technique and progressive muscle relaxation on EEG coherence, stress reactivity, and mental health in black adults. Int J Neurosci. 1989 May;46(1-2):77-86. 171 Rohsenow DJ, Smith RE, Johnson S. Stress management training as a prevention program for heavy social drinkers: cognitions, affect, drinking, and individual differences. Addict Behav. 1985;10(1):45-54. 172 Khalsa SB. Treatment of chronic insomnia with yoga: a preliminary study with sleep-wake diaries. Appl Psychophysiol Biofeedback. 2004 Dec;29(4):269-78. 173 West J, Otte C, Geher K, Johnson J, Mohr DC. Effects of Hatha yoga and African dance on perceived stress, affect, and salivary cortisol. Ann Behav Med. 2004 Oct;28(2):114-8. 174 Wood C. Mood change and perceptions of vitality: a comparison of the effects of relaxation, visualisation and yoga. J R Soc Med. 1993 May;86(5):254-8.

2. Review of the literature

2.8. Musculoskeletal health

While yoga postures have long been associated with musculoskeletal health and physical therapy, there is a lack of quality research to unequivocally establish efficacy. As for other conditions, interventions vary widely and yoga is often combined with other disciplines as part of an integrated intervention. This does not suggest that yoga is not beneficial, only that evidence is insufficient in some areas to draw firm conclusions.

2.8.1. Summary of the evidence

A review of non-pharmacologic therapies for acute and chronic pain175 found fair evidence that yoga (Viniyoga), acupuncture, massage and functional restoration were effective.

A structured review of 381 studies176, of which 20 met the inclusion criteria, found limited support for meditation for lower back pain and some support for yoga and progressive muscle relaxation (PMR) for pain reduction in older adults. The same review found limited support for meditation in Osteoarthritis, and PMR plus guided imagery for Osteoarthritis.

Another systematic review177 found considerable evidence of efficacy for meditation, relaxation and other mind-body therapies as adjuncts in the treatment of chronic low back pain. There was moderate evidence of efficacy for mind-body therapies in the treatment of arthritis. Several small clinical trials have been conducted into yoga specifically for Rheumatoid Arthritis with positive results178.

A randomised controlled trial examining Iyengar yoga therapy in subjects with non-specific chronic low back pain179 found significant improvement in pain intensity, functional disability and pain medication usage. Another RCT180 found a 12-week yoga program superior to conventional therapeutic exercise classes or a self-care book in back-related function.

Table 2.8.1 summarises the results of significant studies in this field.

Search terms: pain, back pain, arthritis, osteo*.

175 Chou R, Huffman LH; American Pain Society; American College of Physicians. Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Ann Intern Med. 2007 Oct 2;147(7):492-504. Summary for patients in: Ann Intern Med. 2007 Oct 2;147(7):I45. 176 Morone NE, Greco CM. Mind-body interventions for chronic pain in older adults: a structured review. Pain Med. 2007 May- Jun;8(4):359-75. 177 Astin JA, Shapiro SL, Eisenberg DM, Forys KL. Mind-body medicine: state of the science, implications for practice. J Am Board Fam Pract. 2003 Mar-Apr;16(2):131-47. 178 Astin JA. Mind-body therapies for the management of pain. Clin J Pain. 2004 Jan-Feb;20(1):27-32. 179 Williams KA, Petronis J, Smith D, Goodrich D, Wu J, Ravi N, Doyle EJ Jr, Gregory Juckett R, Munoz Kolar M, Gross R, Steinberg L. Effect of Iyengar yoga therapy for chronic low back pain. Pain. 2005 May;115(1-2):107-17. 180 Sherman KJ, Cherkin DC, Erro J, Miglioretti DL, Deyo RA. Comparing yoga, exercise, and a self-care book for chronic low back pain: a randomised, controlled trial. Ann Intern Med. 2005 Dec 20;143(12):849-56.

2. Review of the literature

Table 2.8.1. Yoga and meditation for chronic pain, back pain, Arthritis and Osteoarthritis

Study details Summary N= Effect Chou 2007181 A systematic review found fair evidence that acupuncture, massage, yoga n/a 2+ Systematic (Viniyoga), and functional restoration were effective for chronic low back pain. review USA Morone 2007182 A structured review of 381 studies, of which 20 met the inclusion criteria, found n/a 2+ Systematic some support for progressive muscle relaxation (PMR) plus guided imagery for review USA osteoarthritis, limited support for meditation for osteoarthritis or lower back pain and some support for yoga and PMR for pain reduction. Astin 2004183 Relaxation and meditation as part of multi-component mind-body approaches n/a 2+ Review USA may be appropriate adjunct treatment for lower back pain, rheumatoid and osteoarthritis, migraine and tension headache, and may improve operative and post-operative pain and recovery time. Astin 2003184 A review found considerable evidence of efficacy for meditation, relaxation and n/a 2+ Systematic other mind-body therapies as adjuncts in the treatment of coronary artery review USA disease (eg, cardiac rehabilitation), headaches, insomnia, incontinence, chronic low back pain, disease and treatment-related symptoms of cancer, and improving postsurgical outcomes. There was moderate evidence only of efficacy for mind-body therapies in the areas of hypertension and arthritis. Chou 2007185 A clinical practice guideline statement from the American College of Physicians n/a 1+ Case series USA and the American Pain Society on treatment of lower back pain advised that for patients who do not improve with self-care options, clinicians should consider the addition of intensive interdisciplinary rehabilitation, such as exercise therapy, acupuncture, massage therapy, spinal manipulation, yoga, cognitive-behavioral therapy, or progressive relaxation for chronic or subacute low back pain, however the recommendation noted that evidence of efficacy of these approaches was only of moderate quality. Carson 2005186 A program of loving kindness meditation for eight weeks found significant 43 1+ Randomised improvement in pain and psychological distress in patients with chronic low back controlled trial pain. The meditation practice was associated with lower pain that day and lower USA anger the next day. Michalsen An Iyengar yoga program twice a week for three months resulted in significant 24 1+ 2005187 Clinical improvements in perceived stress, anxiety, well-being, vigour, fatigue and trial Germany depression. Physical well-being also increased and those suffering from headache or back pain reported pain relief. Salivary cortisol also decreased significantly after participation in a yoga class.

181 Chou R, Huffman LH; American Pain Society; American College of Physicians. Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Ann Intern Med. 2007 Oct 2;147(7):492-504. Summary for patients in: Ann Intern Med. 2007 Oct 2;147(7):I45. 182 Morone NE, Greco CM. Mind-body interventions for chronic pain in older adults: a structured review. Pain Med. 2007 May- Jun;8(4):359-75. 183 Astin JA. Mind-body therapies for the management of pain. Clin J Pain. 2004 Jan-Feb;20(1):27-32. 184 Astin JA, Shapiro SL, Eisenberg DM, Forys KL. Mind-body medicine: state of the science, implications for practice. J Am Board Fam Pract. 2003 Mar-Apr;16(2):131-47. 185 Chou R, Qaseem A, Snow V, Casey D, Cross JT Jr, Shekelle P, Owens DK; Clinical Efficacy Assessment Subcommittee of the American College of Physicians; American College of Physicians; American Pain Society Low Back Pain Guidelines Panel. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007 Oct 2;147(7):478-91. Summary for patients in: Ann Intern Med. 2007 Oct 2;147(7):I45. 186 Carson JW, Keefe FJ, Lynch TR, Carson KM, Goli V, Fras AM, Thorp SR. Loving-kindness meditation for chronic low back pain: results from a pilot trial. J Holist Nurs. 2005 Sep;23(3):287-304. 187 Michalsen A, Grossman P, Acil A, Langhorst J, Lüdtke R, Esch T, Stefano GB, Dobos GJ. Rapid stress reduction and anxiolysis among distressed women as a consequence of a three-month intensive yoga program. Med Sci Monit. 2005 Dec;11(12):CR555-561. Epub 2005 Nov 24.

2. Review of the literature

Table 2.8.1. (continued)

Study details Summary N= Effect Sherman A 12-week yoga program compared to conventional therapeutic exercise classes 101 1+ 2005188 or a self-care book found back-related function in the yoga group was superior Randomised to the book and exercise groups at 12 weeks. At 26 weeks follow-up, back- controlled trial related function in the yoga group was only superior to the book group. The USA yoga program did not improve bothersomeness over exercise. Williams 2005189 A program of Iyengar yoga therapy was compared to an educational control for 42 1+ Randomised 16 weeks in subjects with non-specific chronic low back pain. Significant controlled trial differences between groups were found in pain intensity, functional disability USA and pain medication usage but not in psychological or behavioral outcomes. Mehling 2005190 A program of breath therapy, comprising body awareness, breathing, 36 1+ Randomised meditation, and movement was compared to physical therapy for chronic lower controlled trial back pain in 12 sessions over six to eight weeks. Patients in both groups USA improved in pain, breath therapy recipients improved in function and in measures of physical and emotional role while physical therapy recipients improved in vitality. Average improvements were not different between groups. At six to eight weeks, results showed a trend favoring breath therapy; at six months, a trend favoring physical therapy. Galantino A six-week modified Hatha yoga protocol for participants with chronic low back 22 +/- 2004191 pain found some improvement in balance and flexibility and decreased disability Randomised and depression for the yoga group, but this was not statistically significant controlled trial possibly due to a high dropout rate in the control group and large baseline USA differences in some measures. Dash 2001192 A study of 37 adults and 86 children found yoga practice improved hand grip 123 1+ Clinical trial strength in normal persons and in patients with rheumatoid arthritis. India Garfinkel An evaluation of yoga for treatment of osteoarthritis of the hands reported n/a 1+ 1994193 reduced pain during activity, tenderness and finger range of motion. Other Randomised trends also favored the yoga intervention. controlled trial USA Haslock 1994194 A small trial found patients with rheumatoid arthritis felt better after yoga, n/a 1+ Clinical trial increased hand grip strength and improved in subjective health assessment India scores and left hand ring sizes. Kolasinski A pilot study of Iyengar yoga for osteoarthritis of the knee found that yoga may n/a 1+ 2005195 Clinical be a feasible treatment option for obese patients >50 years of age and offers trial USA potential reductions in pain and disability.

188 Sherman KJ, Cherkin DC, Erro J, Miglioretti DL, Deyo RA. Comparing yoga, exercise, and a self-care book for chronic low back pain: a randomised, controlled trial. Ann Intern Med. 2005 Dec 20;143(12):849-56. 189 Williams KA, Petronis J, Smith D, Goodrich D, Wu J, Ravi N, Doyle EJ Jr, Gregory Juckett R, Munoz Kolar M, Gross R, Steinberg L. Effect of Iyengar yoga therapy for chronic low back pain. Pain. 2005 May;115(1-2):107-17. 190 Mehling WE, Hamel KA, Acree M, Byl N, Hecht FM. Randomised, controlled trial of breath therapy for patients with chronic low-back pain. Altern Ther Health Med. 2005 Jul-Aug;11(4):44-52. 191 Galantino ML, Bzdewka TM, Eissler-Russo JL, Holbrook ML, Mogck EP, Geigle P, Farrar JT. The impact of modified Hatha yoga on chronic low back pain: a pilot study. Altern Ther Health Med. 2004 Mar-Apr;10(2):56-9. 192 Dash M, Telles S. Improvement in hand grip strength in normal volunteers and rheumatoid arthritis patients following yoga training. Indian J Physiol Pharmacol. 2001 Jul;45(3):355-60. 193 Garfinkel MS, Schumacher HR Jr, Husain A, Levy M, Reshetar RA. Evaluation of a yoga based regimen for treatment of osteoarthritis of the hands. J Rheumatol. 1994 Dec;21(12):2341-3. 194 Haslock I, Monro R, Nagarathna R, Nagendra HR, Raghuram NV. Measuring the effects of yoga in rheumatoid arthritis. Br J Rheumatol. 1994 Aug;33(8):787-8. 195 Kolasinski SL, Garfinkel M, Tsai AG, Matz W, Van Dyke A, Schumacher HR. Iyengar yoga for treating symptoms of osteoarthritis of the knees: a pilot study. J Altern Complement Med. 2005 Aug;11(4):689-93.

2. Review of the literature

2.9. Womens’ health

Womens’ health includes pre and post pregnancy, Pre-Menstrual Syndrome and the symptoms of Menopause.

2.9.1. Summary of the evidence

A systematic review of 82 studies196, of which 20 RCT comprising 958 subjects were included, found a strong level of efficacy for yoga in pre-menstrual syndrome and menopausal symptoms as well a variety of other general complaints such as epilepsy, nonpsychotic mood and anxiety disorders, autoimmune illness, and emotional disturbance in neoplastic disease.

A single clinical trial in pregnancy197 involved a yoga intervention of postures, breathing and meditation commencing from 18 to 20 weeks gestation for one hour each day compared with walking for 30 minutes twice a day. The yoga intervention group had significantly lower rates of pre-term labour, significantly more babies over 2.5kg and significantly fewer complications such as pregnancy-induced hypertension and isolated intrauterine growth retardation.

Two small clinical trials into yoga for menopausal symptoms198,199 have reported improvement in the number and severity of hot flushes and improved sleep.

Table 2.9.1 summarises the results of significant studies in this field.

Search terms: women, pregnan*, menopaus*, menstrual.

196 Arias AJ, Steinberg K, Banga A, Trestman RL. Systematic review of the efficacy of meditation techniques as treatments for medical illness. J Altern Complement Med. 2006 Oct;12(8):817-32. 197 Narendran S, Nagarathna R, Narendran V, Gunasheela S, Nagendra HR. Efficacy of yoga on pregnancy outcome. J Altern Complement Med. 2005 Apr;11(2):237-44. 198 Booth-LaForce C, Thurston RC, Taylor MR. A pilot study of a Hatha yoga treatment for menopausal symptoms. Maturitas. 2007 Jul 20;57(3):286-95. Epub 2007 Mar 2. 199 Cohen BE, Kanaya AM, Macer JL, Shen H, Chang AA, Grady D. Feasibility and acceptability of restorative yoga for treatment of hot flushes: a pilot trial. Maturitas. 2007 Feb 20;56(2):198-204. Epub 2006 Sep 18.

2. Review of the literature

Table 2.9.1. Yoga and meditation for womens health: pregnancy, symptoms of Menopause, and Pre-Menstrual syndrome.

Study details Summary N= Effect Pennick 2007200 A Cochrane review found eight studies with a total of 1305 participants that n/a +/- Systematic examined the effects of adding various pregnancy-specific exercises, review Canada physiotherapy, acupuncture and pillows to usual prenatal care. Although yoga was not specifically investigated, women with low-back pain and/or pelvic pain, benefited from participating in strengthening exercises, stretching exercises and sitting pelvic tilt exercises, and reported less use of analgesics, physical modalities and sacroiliac belts over usual prenatal care alone. Arias 2006201 In a review of 82 studies, 20 RCTs comprising 958 subjects met the inclusion 958 2+ Systematic criteria. The strongest evidence for efficacy was found for epilepsy, symptoms review USA of premenstrual syndrome and menopausal symptoms. Benefit was also demonstrated for nonpsychotic mood and anxiety disorders, autoimmune illness, and emotional disturbance in neoplastic disease. Kronenberg A systematic review did not find any eligible studies relating to yoga for n/a +/- 2002202 Review menopausal symptoms. USA Elavsky 2007203 The effect of walking in a group three times a week for an hour was compared 164 +/- Randomised to a 90 minute yoga class twice weekly on self-esteem in menopausal women controlled trial over 4 months. Both interventions failed to enhance global or physical self- USA esteem but improved some measures of esteem related to physical condition and strength (for walking) and body attractiveness (for both walking and yoga). Elavsky 2007204 A four-month program of walking or yoga failed to show significant 164 1- Randomised improvements in sleep quality in menopausal women. controlled trial USA Narendran The effect of a program of yoga postures, breathing and meditation practised 335 1+ 2005205 Clinical for one hour daily, commencing from 18 to 20 weeks gestation and continued trial India until delivery, was compared to walking for 30 minutes twice a day on pregnancy outcomes. The number of babies with birth weight above 2.5kg was significantly higher, preterm labor was significantly lower, and complications such as isolated intrauterine growth retardation and pregnancy-induced hypertension were significantly lower in the yoga group. There were no significant adverse effects noted. Walton 2004206 Women who were long term Transcendental Meditation (TM) practitioners 30 1+ Clinical trial USA were found to have lower cortisol response to metabolic challenge possibly via improved endocrine regulation. The number of months practising TM was inversely correlated with heart disease risk factors.

200 Pennick VE, Young G. Interventions for preventing and treating pelvic and back pain in pregnancy. Cochrane Database Syst Rev. 2007 Apr 18;(2):CD001139. 201 Arias AJ, Steinberg K, Banga A, Trestman RL. Systematic review of the efficacy of meditation techniques as treatments for medical illness. J Altern Complement Med. 2006 Oct;12(8):817-32. 202 Kronenberg F, Fugh-Berman A. Complementary and alternative medicine for menopausal symptoms: a review of randomised, controlled trials. Ann Intern Med. 2002 Nov 19;137(10):805-13. 203 Elavsky S, McAuley E. Exercise and self-esteem in menopausal women: a RCT involving walking and yoga. Am J Health Promot. 2007 Nov-Dec;22(2):83-92. 204 Elavsky S, McAuley E. Lack of perceived sleep improvement after 4-month structured exercise programs. Menopause. 2007 May-Jun;14(3 Pt 1):535-40. 205 Narendran S, Nagarathna R, Narendran V, Gunasheela S, Nagendra HR. Efficacy of yoga on pregnancy outcome. J Altern Complement Med. 2005 Apr;11(2):237-44. 206 Walton KG, Fields JZ, Levitsky DK, Harris DA, Pugh ND, Schneider RH. Lowering cortisol and CVD risk in postmenopausal women: a pilot study using the Transcendental Meditation program. Ann N Y Acad Sci. 2004 Dec;1032:211-5.

2. Review of the literature

Table 2.9.1. (continued)

Damodaran One hour of daily yoga practice for three months was shown to decrease blood 20 1+ 2002207 Clinical pressure and drug score, blood glucose, cholesterol and triglycerides, while trial India subjective well-being and quality of life improved. Schell 1994208 The effect of Hatha yoga practice was compared to a book reading control n/a 1+ Clinical trial group. The yoga group showed markedly higher scores in life satisfaction and Germany lower scores in excitability, aggressiveness, openness, emotionality and somatic complaints. Significant differences were also observed in coping with stress and mood. Booth-LaForce A yoga program comprising breathing techniques, postures and relaxation for 12 1+ 2007209 Clinical 15 minutes daily and a once weekly class found significant improvement in trial USA severity of self-reported menopausal symptoms such as hot-flash daily interference, and sleep efficiency, disturbances and quality, suggesting a basis for further research. Cohen 2006210 A program of eight restorative yoga poses taught in a three-hour introductory 14 1+ Clinical trial USA session followed by 8 weekly 90 classes found a large reduction in number and severity of hot flushes in a small group of post-menopausal women.

207 Damodaran A, Malathi A, Patil N, Shah N, Suryavansihi, Marathe S. Therapeutic potential of yoga practices in modifying cardiovascular risk profile in middle aged men and women. J Assoc Physicians India. 2002 May;50(5):633-40. 208 Schell FJ, Allolio B, Schonecke OW. Physiological and psychological effects of Hatha-Yoga exercise in healthy women. Int J Psychosom. 1994;41(1-4):46-52. 209 Booth-LaForce C, Thurston RC, Taylor MR. A pilot study of a Hatha yoga treatment for menopausal symptoms. Maturitas. 2007 Jul 20;57(3):286-95. Epub 2007 Mar 2. 210 Cohen BE, Kanaya AM, Macer JL, Shen H, Chang AA, Grady D. Feasibility and acceptability of restorative yoga for treatment of hot flushes: a pilot trial. Maturitas. 2007 Feb 20;56(2):198-204. Epub 2006 Sep 18.

2. Review of the literature

2.10. Respiratory health

There are many different breathing techniques (pranayama) available in yoga and there would seem to be good potential for the use of pranayama in all respiratory conditions. However, at present evidence is lacking.

2.10.1. Summary of the evidence A systematic review211 found that improved control of breathing with yoga may contribute to the control of asthma symptoms, however due to the small number of controlled trials and participants it was not possible to draw firm conclusions.

An Australian RCT into Sahaja (meditative) yoga212 found limited beneficial effects on some objective and subjective measures of asthma. Three RCTs conducted in India investigated yoga and asthma213,214,215; two RCTs in adults and one in children, all of which showed a positive effect. One further RCT in adults with Chronic Obstructive Pulmonary Disease (COPD)216 also showed a positive effect.

Progressive muscle relaxation has also been investigated and a systematic review217 found nine trials which met the selection criteria. Two out of five trials found a significant benefit for progressive muscle relaxation for asthma. Otherwise, the studies were seen to be flawed and results equivocal.

Table 2.10.1 summarises the results of significant studies in this field.

Search terms: respirat*, asthma, bronch*, COPD, obstructive, pulmonary.

211 Steurer-Stey C, Russi EW, Steurer J. Complementary and alternative medicine in asthma: do they work? Swiss Med Wkly. 2002 Jun 29;132(25-26):338-44. 212 Manocha R, Marks GB, Kenchington P, Peters D, Salome CM. Sahaja yoga in the management of moderate to severe asthma: a RCT. Thorax. 2002 Feb;57(2):110-5. 213 Nagendra HR, Nagarathna R. An integrated approach of yoga therapy for bronchial asthma: a 3-54-month prospective study. J Asthma. 1986;23(3):123-37. 214 Nagarathna R, Nagendra HR. Yoga for bronchial asthma: a controlled study. Br Med J (Clin Res Ed). 1985 Oct 19;291(6502):1077-9. 215 Jain SC, Rai L, Valecha A, Jha UK, Bhatnagar SO, Ram K. Effect of yoga training on exercise tolerance in adolescents with childhood asthma. J Asthma. 1991;28(6):437-42. 216 Behera D. Yoga therapy in chronic bronchitis. J Assoc Physicians India. 1998 Feb;46(2):207-8. 217 Huntley A, White AR, Ernst E. Relaxation therapies for asthma: a SR. Thorax. 2002 Feb;57(2):127-31.

2. Review of the literature

Table 2.10.1. Yoga and meditation for respiratory conditions including Asthma, Bronchitis and COPD

Study details Summary N= Effect Ram 2003218 A review of breathing retraining for asthma found six trials that met the n/a +/- Systematic selection criteria. Individual trials suggested that breathing retraining may review UK have a role in the treatment and management of asthma; however, no firm conculsions could be drawn based on limited studies. Huntley 2002219 A review of relaxation therapies for asthma found nine trials met the n/a +/- Systematic selection criteria. Two out of five trials found a significant benefit for review UK progressive muscle relaxation for asthma. There was some evidence that muscular relaxation improves lung function of patients with asthma. Otherwise, the studies were seen to be flawed and results equivocal. Steurer-Stey A review found that improved control of breathing through yoga may n/a +/- 2002220 Review contribute to the control of asthma symptoms, but due to the small number Switzerland of controlled trials and the small number of patients it was not possible to draw firm conclusions. Sabina 2005221 A pilot study into yoga for adults with mild to moderate asthma found no 45 1- Randomised significant differences between yoga and control groups on any outcome controlled trial measures. USA Cooper 2003222 A randomised controlled trial found Buteyko breathing technique improved 69 1- Randomised symptoms and reduced bronchodilator use. No benefit was shown for the controlled trial Pink City Lung Exerciser used to mimic yoga pranayama breathing. UK Manocha 2002223 A program of Sahaja (meditative) yoga was found to have limited beneficial 47 1+ Randomised effect on some objective and subjective measures of asthma. controlled trial Australia Vedanthan A program of yoga postures and breathing techniques resulted in improved 17 +/- 1998224 relaxation, attitude, exercise tolerance and less use of inhalers, however Randomised there was no significant difference in pulmonary function. controlled trial India Khanam 1996225 A program of seven days yoga training, resulted in decreased resting heart n/a +/- Clinical trial India rate and sympathetic activity. Pulmonary function improved on some outcome measures but not others. Singh 1990226 Use of a Pink City Lung Exerciser to mimic pranayama twice a day for two 18 +/- Randomised weeks resulted in small but insignificant improvements in some measures of controlled trial pulmonary function. UK

218 Ram FS, Holloway EA, Jones PW. Breathing retraining for asthma. Respir Med. 2003 May;97(5):501-7. 219 Huntley A, White AR, Ernst E. Relaxation therapies for asthma: a SR. Thorax. 2002 Feb;57(2):127-31. 220 Steurer-Stey C, Russi EW, Steurer J. Complementary and alternative medicine in asthma: do they work? Swiss Med Wkly. 2002 Jun 29;132(25-26):338-44. 221 Sabina AB, Williams AL, Wall HK, Bansal S, Chupp G, Katz DL. Yoga intervention for adults with mild-to-moderate asthma: a pilot study. Ann Allergy Asthma Immunol. 2005 May;94(5):543-8. 222 Cooper S, Oborne J, Newton S, Harrison V, Thompson Coon J, Lewis S, Tattersfield A. Effect of two breathing exercises (Buteyko and pranayama) in asthma: a RCT. Thorax. 2003 Aug; 58(8):674-9. 223 Manocha R, Marks GB, Kenchington P, Peters D, Salome CM. Sahaja yoga in the management of moderate to severe asthma: a RCT. Thorax. 2002 Feb;57(2):110-5. 224 Vedanthan PK, Kesavalu LN, Murthy KC, Duvall K, Hall MJ, Baker S, Nagarathna S. Clinical study of yoga techniques in university students with asthma: a controlled study. Allergy Asthma Proc. 1998 Jan-Feb;19(1):3-9. 225 Khanam AA, Sachdeva U, Guleria R, Deepak KK. Study of pulmonary and autonomic functions of asthma patients after yoga training. Indian J Physiol Pharmacol. 1996 Oct;40(4):318-24. 226 Singh V, Wisniewski A, Britton J, Tattersfield A. Effect of yoga breathing exercises (pranayama) on airway reactivity in subjects with asthma. Lancet. 1990 Jun 9;335(8702):1381-3.

2. Review of the literature

Table 2.10.1 (continued)

Study details Summary N= Effect Nagendra A follow-up study over 3 to 54 months of 570 bronchial asthmatics (7-78 570 1+ 1986227 years) who had undertaken a two to four week yoga training program, Randomised comprising pranayama, meditation, kriyas (cleansing techniques) and theory controlled trial of yoga, showed significant improvement in most of the parameters including India peak flow rates and 72, 69, and 66% of the patients stopped or reduced parenteral, oral, and cortisone medication, respectively. Those who practised yoga regularly showed the greatest improvement. Nagarathna A program of yoga postures, pranayama, meditation and devotional session 53 1+ 1985228 practised for 65 minutes a day for two weeks, resulted in less asthma Randomised attacks, less use of drugs and improved peak flow rate. controlled trial India Behera 1998229 A program of yoga postures and breathing for four weeks for chronic 15 1+ Clinical trial India bronchitis (COPD) sufferers, resulted in a perceptible improvement in dyspnoea and lung function parameters. Jain 1991230 Yoga training for children with asthma resulted in a significant increase in 46 1+ India pulmonary function and exercise capacity and a follow-up study over two years showed reduced symptom scores and drug requirements.

227 Nagendra HR, Nagarathna R. An integrated approach of yoga therapy for bronchial asthma: a 3-54-month prospective study. J Asthma. 1986;23(3):123-37. 228 Nagarathna R, Nagendra HR. Yoga for bronchial asthma: a controlled study. Br Med J (Clin Res Ed). 1985 Oct 19;291(6502):1077-9. 229 Behera D. Yoga therapy in chronic bronchitis. J Assoc Physicians India. 1998 Feb;46(2):207-8. 230 Jain SC, Rai L, Valecha A, Jha UK, Bhatnagar SO, Ram K. Effect of yoga training on exercise tolerance in adolescents with childhood asthma. J Asthma. 1991;28(6):437-42.

2. Review of the literature

2.11. Gastrointestinal health

As for respiratory conditions, there have been very few studies of any note conducted into yoga for Irritable Bowel Syndrome, Pancreatitis or other gastrointestinal complaints.

2.11.1. Summary of the evidence A single randomised controlled trial found a yoga intervention for Pancreatitis significantly improved overall quality of life, alcohol dependence and appetite. Of the three RCTs of yoga for Irritable Bowel Syndrome (IBS) shown below, two showed a potential benefit with one equivocal.

Table 2.11.1 summarises the results of significant studies in this field.

Search terms: irritable, IBS, pancreat*, gastro*.

Table 2.11.1. Yoga and meditation for gastrointestinal symptoms, Irritable Bowel Syndrome (IBS), and Pancreatitis

Study details Summary N= Effect Sareen 2007231 A program of yoga twice a week for 12 weeks for patients with chronic 60 1+ Randomised pancreatitis found significant improvement in overall quality of life, symptoms controlled trial UK of stress, mood changes, alcohol dependence, and appetite. Kuttner 2006232 A yoga intervention comprising a 1 hour instruction session followed by 4 25 1+ Randomised weeks of home practice guided by a video, resulted in significantly lower controlled trial scores for gastrointestinal symptoms and emotion-focused avoidance, and Canada lower levels of functional disability and anxiety. Taneja 2004233 A yoga program of postures and right nostril breathing twice a day for 2 22 +/- Randomised months resulted in a significant decrease of bowel symptoms and state controlled trial anxiety but not significantly more than the conventional treatment control India group. Parasympathetic reactivity increased in the yoga group. Keefer 2001234 Herbert Benson's Relaxation Response meditation program, practised for 15 16 1+ Randomised minutes, twice daily for six weeks, resulted in significant improvements in controlled trial self-reported flatulence, belching, bloating and diarrhea at the three month USA follow up. Improvement in constipation was not significant. Blanchard 1992235 A multi-component treatment for irritable bowel syndrome (IBS) including n/a +/- Clinical trial USA relaxation, thermal biofeedback and cognitive therapy was compared to a pseudo-meditation and EEG alpha suppression biofeedback program and control. Results in favour of the multicomponent were insignificant and otherwise equivocal. Significant reductions in GI symptoms in both groups were maintained over a six month follow-up.

231 Sareen S, Kumari V, Gajebasia KS, Gajebasia NK. Yoga: a tool for improving the quality of life in chronic pancreatitis. World J Gastroenterol. 2007 Jan 21;13(3):391-7. 232 Kuttner L, Chambers CT, Hardial J, Israel DM, Jacobson K, Evans K. A randomised trial of yoga for adolescents with irritable bowel syndrome. Pain Res Manag. 2006 Winter;11(4):217-23. 233 Taneja I, Deepak KK, Poojary G, Acharya IN, Pandey RM, Sharma MP. Yogic versus conventional treatment in diarrhea- predominant irritable bowel syndrome: a randomised control study. Appl Psychophysiol Biofeedback. 2004 Mar;29(1):19-33. 234 Keefer L, Blanchard EB. The effects of relaxation response meditation on the symptoms of irritable bowel syndrome: results of a controlled treatment study. Behav Res Ther. 2001 Jul;39(7):801-11. 235 Blanchard EB, Schwarz SP, Suls JM, Gerardi MA, Scharff L, Greene B, Taylor AE, Berreman C, Malamood HS. Two controlled evaluations of multicomponent psychological treatment of irritable bowel syndrome. Behav Res Ther. 1992 Mar;30(2):175-89.

2. Review of the literature

2.12. Cognitive function/neurological health

This category includes Epilepsy, headache, migraine, Attention Deficit Hyperactivity Disorder (ADHD) cognition, Multiple Sclerosis (MS), Carpal Tunnel Syndrome and non-musculoskeletal pain management.

2.12.1. Summary of the evidence A systematic review of 82 studies236, of which 20 RCTs comprising 958 subjects met the inclusion criteria, explored various clinical conditions. The strongest evidence for efficacy was found for epilepsy, along with other conditions discussed in earlier sections.

Regarding headaches, there have been two systematic reviews237 which found evidence of efficacy for meditation, relaxation and other mind-body therapies as adjuncts in the treatment of headaches, migraine and tension headache.

An Australian systematic review of 21 clinical trials for the treatment of carpal tunnel syndrome238 found significant short-term benefit from yoga. Another systematic review of therapies for carpal tunnel syndrome239 found some evidence for yoga intervention.

A single small RCT into a yoga intervention for ADHD240 showed improvement in attention and parental ratings of ADHD symptoms.

Table 2.12.1 summarises the results of significant studies in this field.

Search terms: pain, headache, migraine, cognit*, motor skill*, percept*, ADHD, attention deficit*, epilepsy, sclerosis, carpal*.

236 Arias AJ, Steinberg K, Banga A, Trestman RL. Systematic review of the efficacy of meditation techniques as treatments for medical illness. J Altern Complement Med. 2006 Oct;12(8):817-32. 237 Astin JA. Mind-body therapies for the management of pain. Clin J Pain. 2004 Jan-Feb;20(1):27-32. 238 O'Connor D, Marshall S, Massy-Westropp N. Non-surgical treatment (other than steroid injection) for carpal tunnel syndrome. Cochrane Database Syst Rev. 2003;(1):CD003219. 239 Muller M, Tsui D, Schnurr R, Biddulph-Deisroth L, Hard J, MacDermid JC. Effectiveness of hand therapy interventions in primary management of carpal tunnel syndrome: a SR. J Hand Ther. 2004 Apr-Jun;17(2):210-28. 240 Haffner J, Roos J, Goldstein N, Parzer P, Resch F. The effectiveness of body-oriented methods of therapy in the treatment of attention-deficit hyperactivity disorder (ADHD): results of a controlled pilot study. Z Kinder Jugendpsychiatr Psychother. 2006 Jan;34(1):37-47.

2. Review of the literature

Table 2.12.1. Yoga and meditation for pain management, headaches and migraine, motor skills, cognitive function, Carpal Tunnel Syndrome, Multiple Sclerosis, and Attention Deficit Hyperactivity Disorder (ADHD)

Study details Summary N= Effect Morone 2007241 A structured review of 381 studies, of which 20 met the inclusion criteria, n/a 2+ Systematic found some support for progressive muscle relaxation (PMR) plus guided review USA imagery for osteoarthritis, limited support for meditation for osteoarthritis or lower back pain, and some support for yoga and PMR for pain reduction. Piazzini 2007242 A systematic review of 33 RCTs found limited or conflicting evidence of n/a +/- Review Italy effectiveness of yoga for Carpal Tunnel Syndrome. Arias 2006243 In a review of 82 studies, 20 RCTs comprising 958 subjects met the inclusion 958 2+ Systematic criteria. The strongest evidence for efficacy was found for epilepsy, review USA symptoms of premenstrual syndrome and menopausal symptoms. Benefit was also demonstrated for nonpsychotic mood and anxiety disorders, autoimmune illness, and emotional disturbance in neoplastic disease. Walker 2007244 A review found reasonable evidence that cognitive behavioral approaches n/a 1+ Review USA were beneficial in the treatment of depression and in helping people adjust to and cope with having MS. Astin 2003245 A review found considerable evidence of efficacy for meditation, relaxation n/a 2+ Systematic and other mind-body therapies as adjuncts in the treatment of coronary review USA artery disease (eg, cardiac rehabilitation), headaches, insomnia, incontinence, chronic low back pain, disease and treatment-related symptoms of cancer, and improving postsurgical outcomes. There was moderate evidence only of efficacy for mind-body therapies in the areas of hypertension and arthritis. Astin 2004246 A review of mind-body therapies for the management of pain found n/a 2+ Review USA relaxation and meditation as part of multi-component approaches may be appropriate for lower back pain, rheumatoid and osteoarthritis, migraine and tension headache, and may improve operative and post-operative pain and recovery time. Muller 2004247 A systematic review of therapies for Carpal Tunnel Syndrome found some n/a 1+ Review Canada evidence for splinting, ultrasound, nerve gliding exercises, carpal bone mobilisation, magnetic therapy, and yoga. Canter 2003248 A review of the literature for Transcendental Meditation (TM), testing claims n/a +/- Systematic of increased cognitive function and intelligence found 10 trials that met the review UK inclusion criteria, however the reviewers found the trials procedurally inadequate or conflicting, concluding that there is currently no evidence of efficacy.

241 Morone NE, Greco CM. Mind-body interventions for chronic pain in older adults: a structured review. Pain Med. 2007 May- Jun;8(4):359-75. 242 Piazzini DB, Aprile I, Ferrara PE, Bertolini C, Tonali P, Maggi L, Rabini A, Piantelli S, Padua L. A systematic review of conservative treatment of carpal tunnel syndrome. Clin Rehabil. 2007 Apr;21(4):299-314. 243 Arias AJ, Steinberg K, Banga A, Trestman RL. Systematic review of the efficacy of meditation techniques as treatments for medical illness. J Altern Complement Med. 2006 Oct;12(8):817-32. 244 Walker ID, Gonzalez EW. Review of intervention studies on depression in persons with multiple sclerosis. Issues Ment Health Nurs. 2007 May;28(5):511-31. 245 Astin JA, Shapiro SL, Eisenberg DM, Forys KL. Mind-body medicine: state of the science, implications for practice. J Am Board Fam Pract. 2003 Mar-Apr;16(2):131-47. 246 Astin JA. Mind-body therapies for the management of pain. Clin J Pain. 2004 Jan-Feb;20(1):27-32. 247 Muller M, Tsui D, Schnurr R, Biddulph-Deisroth L, Hard J, MacDermid JC. Effectiveness of hand therapy interventions in primary management of carpal tunnel syndrome: a SR. J Hand Ther. 2004 Apr-Jun;17(2):210-28. 248 Canter PH, Ernst E. The cumulative effects of Transcendental Meditation on cognitive function--a systematic review of RCTs. Wien Klin Wochenschr. 2003 Nov 28;115(21-22):758-66.

2. Review of the literature

Table 2.12.1 (continued)

Study details Summary N= Effect O'Connor 2003249 A systematic review of 21 clinical trials for Carpal Tunnel Syndrome found 884 3+ Systematic significant short-term benefit from oral steroids, splinting, ultrasound, yoga review Australia and carpal bone mobilisation. Brañas 2000250 A systematic review of alternative therapies such as acupuncture, n/a +/- Review UK acupressure and yoga for treatment of fatigue in Multiple Sclerosis failed to find any studies that met the selection criteria. Jaseja 2006251 Neuro-imaging studies during the course and attainment of a meditative n/a +/- Article India state have revealed a rise in brain glutamate and serotonin along with development of hypersynchrony of EEG activity, which are well documented to form the underlying basis of epilepsy. Therefore, a theoretical risk of inducing susceptibility and decreasing threshold to epilepsy exists in meditation. Studies on meditators have reported various adverse outcomes and one such study has reported significantly higher incidence of complex partial epileptic-like signs and experiences in a large sample. Goodyear-Smith A systematic review found limited evidence to indicate that yoga may be n/a 1+ 2004252 Review effective in the short to medium term for Carpal Tunnel Syndrome. New Zealand Gerritsen 2002253 A systematic review found that yoga seemed to be ineffective in providing n/a 2- Systematic short-term symptom relief for Carpal Tunnel Syndrome. review Netherlands Arnold 2001254 A review of alternative treatments for adults with ADHD found only a small n/a 0 Review USA promising pilot trial of meditation for ADHD. Ramaratnam A systematic review found only one small RCT of Sahaja yoga met the n/a +/- 2000255 inclusion criteria. Despite generally positive results in that study, the Systematic reviewers reported that no reliable conclusions can be drawn regarding the review India efficacy of yoga as a treatment for epilepsy. John 2007256 A three-month program of yoga therapy for migraine without aura resulted in 72 1+ Randomised a significant reduction in headache intensity, pain and affective pain indices, controlled trial anxiety and depression scores and medication use. India Sharma 2006257 Eight weeks of Sahaj (meditative) yoga improved cognitive function in a 30 +/- Randomised letter cancellation test and a reverse digit span test, but not on other controlled trial measures. India

249 O'Connor D, Marshall S, Massy-Westropp N. Non-surgical treatment (other than steroid injection) for carpal tunnel syndrome. Cochrane Database Syst Rev. 2003;(1):CD003219. 250 Brañas P, Jordan R, Fry-Smith A, Burls A, Hyde C. Treatments for fatigue in multiple sclerosis: a rapid and SR. Health Technol Assess. 2000;4(27):1-61. 251 Jaseja H. Meditation potentially capable of increasing susceptibility to epilepsy - a follow-up hypothesis. Med Hypotheses. 2006;66(5):925-8. Epub 2006 Jan 24. 252 Goodyear-Smith F, Arroll B. What can family physicians offer patients with carpal tunnel syndrome other than surgery? A systematic review of nonsurgical management. Ann Fam Med. 2004 May-Jun;2(3):267-73. 253 Gerritsen AA, de Krom MC, Struijs MA, Scholten RJ, de Vet HC, Bouter LM. Conservative treatment options for carpal tunnel syndrome: a systematic review of RCTs. J Neurol. 2002 Mar;249(3):272-80. 254 Arnold LE. Alternative treatments for adults with attention-deficit hyperactivity disorder (ADHD). Ann N Y Acad Sci. 2001 Jun;931:310-41. 255 Ramaratnam S, Sridharan K. Yoga for epilepsy. The Cochrane Database of SRs 2000, Issue 1. Art. No.: CD001524 256 John PJ, Sharma N, Sharma CM, Kankane A. Effectiveness of yoga therapy in the treatment of migraine without aura: a RCT. Headache. 2007 May;47(5):654-61. 257 Sharma VK, Das S, Mondal S, Goswami U, Gandhi A. Effect of Sahaj Yoga on neuro-cognitive functions in patients suffering from major depression. Indian J Physiol Pharmacol. 2006 Oct-Dec;50(4):375-83.

2. Review of the literature

Table 2.12.1 (continued)

Study details Summary N= Effect Haffner 2006258 The effect of a yoga intervention in children with attention deficit 19 1+ Randomised hyperactivity disorder (ADHD) was compared to conventional motor controlled trial exercises. The yoga intervention achieved medium to high effect sizes on all Germany measures; test scores on an attention task and parent ratings of ADHD symptoms. The yoga training was particularly effective for children undergoing pharmacotherapy. Rajesh 2006259 A yoga and meditation program for 20 minutes twice daily (mornings and 20 1+ Clinical trial India evenings) at home with supervised sessions weekly for three months was investigated in patients with drug-resistant chronic epilepsy. Participants achieved a substantial reduction in seizure frequency and those who continued the program beyond three and six months experienced the greatest reductions in seizure frequency. Some became seizure free. Orme-Johnson Functional magnetic resonance imaging (MRI) found that long-term n/a 1+ 2006260 Clinical practitioners of the Transcendental Meditation (TM) technique showed 40- trial USA 50% fewer voxels responding to pain in the thalamus and total brain than in healthy matched controls. After the controls learned the technique and practised it for five months, their response also decreased by 40-50% in the thalamus, prefrontal cortex, total brain, and marginally in the anterior cingulate cortex. Michalsen An Iyengar yoga program twice a week for three months resulted in 24 1+ 2005261 Clinical significant improvements in perceived stress, anxiety, well-being, vigor, trial Germany fatigue and depression. Physical well-being also increased and those suffering from headache or back pain reported pain relief. Salivary cortisol also decreased significantly after participation in a yoga class. Jensen 2004262 A small trial of yoga for boys with ADHD reported conflicting results, partly 19 +/- Randomised because the study was under-powered, however that yoga may still have controlled trial merit as a complementary treatment for boys with ADHD already stabilised Australia on medication. Oken 2004263 A six-month Iyengar yoga program comprising a weekly class and home 69 +/- Randomised practice was compared to an exercise program. Both programs resulted in controlled trial some improvement in measures of energy and fatigue but no significant USA changes in mood or cognitive function. Garfinkel 1998264 A study compared a yoga program comprising postures and relaxation twice 42 1+ Randomised weekly for eight weeks with wrist splinting. The yoga group had significant controlled trial improvement in grip strength and pain reduction, but no significant USA differences were found in sleep disturbance, Tinel sign, median nerve motor or sensory conduction time.

258 Haffner J, Roos J, Goldstein N, Parzer P, Resch F. The effectiveness of body-oriented methods of therapy in the treatment of attention-deficit hyperactivity disorder (ADHD): results of a controlled pilot study. Z Kinder Jugendpsychiatr Psychother. 2006 Jan;34(1):37-47. 259 Rajesh B, Jayachandran D, Mohandas G, Radhakrishnan K. A pilot study of a yoga meditation protocol for patients with medically refractory epilepsy. J Altern Complement Med. 2006 May;12(4):367-71. 260 Orme-Johnson DW, Schneider RH, Son YD, Nidich S, Cho ZH. Neuroimaging of meditation's effect on brain reactivity to pain. Neuroreport. 2006 Aug 21;17(12):1359-63. 261 Michalsen A, Grossman P, Acil A, Langhorst J, Lüdtke R, Esch T, Stefano GB, Dobos GJ. Rapid stress reduction and anxiolysis among distressed women as a consequence of a three-month intensive yoga program. Med Sci Monit. 2005 Dec;11(12):CR555- 561. Epub 2005 Nov 24. 262 Jensen PS, Kenny DT. The effects of yoga on the attention and behavior of boys with Attention-Deficit/hyperactivity Disorder (ADHD). J Atten Disord. 2004 May;7(4):205-16. 263 Oken BS, Kishiyama S, Zajdel D, Bourdette D, Carlsen J, Haas M, Hugos C, Kraemer DF, Lawrence J, Mass M. RCT of yoga and exercise in multiple sclerosis. Neurology. 2004 Jun 8;62(11):2058-64. 264 Garfinkel MS, Singhal A, Katz WA, Allan DA, Reshetar R, Schumacher HR Jr. Yoga-based intervention for carpal tunnel syndrome: a randomised trial. JAMA. 1998 Nov 11;280(18):1601-3.

2. Review of the literature

Table 2.12.1 (continued)

Study details Summary N= Effect Naveen 1997265 Yoga breathing techniques including right nostril breathing, left nostril 108 1+ Randomised breathing, alternate nostril breathing, or breath awareness were tested in a controlled trial group of school children for ten days. All four groups showed a significant India average increase of 84% in spatial cognitive task test scores over control, but not in verbal task scores. Manjunath One month of yoga training was found to significantly increase perceptual 80 1+ 1999266 Clinical motor skills in a tweezer dexterity task over controls. trial India Panjwani 1996267 A program of Sahaja yoga meditation twice daily for six months reported a 32 1+ Randomised 62% decrease in seizure frequency at three months and a further decrease controlled trial of 86% at six months. India Wood 1986268 A small trial found meditation and relaxation had no significant effect on fine 32 1- Randomised motor and gross motor skills. controlled trial -

265 Naveen KV, Nagarathna R, Nagendra HR, Telles S. Yoga breathing through a particular nostril increases spatial memory scores without lateralized effects. Psychol Rep. 1997 Oct;81(2):555-61. 266 Manjunath NK, Telles S. Factors influencing changes in tweezer dexterity scores following yoga training. Indian J Physiol Pharmacol. 1999 Apr;43(2):225-9. 267 Panjwani U, Selvamurthy W, Singh SH, Gupta HL, Thakur L, Rai UC. Effect of Sahaja yoga practice on seizure control & EEG changes in patients of epilepsy. Indian J Med Res. 1996 Mar;103:165-72. 268 Wood CJ. Evaluation of meditation and relaxation on physiological response during the performance of fine motor and gross motor tasks. Percept Mot Skills. 1986 Feb;62(1):91-8.

2. Review of the literature

2.13. Cancer care

Yoga interventions for cancer generally aim to treat symptoms related to chemotherapy and radiotherapy, as well as the depression, anxiety, and sleep disturbances often associated with cancer.

2.13.1. Summary of the evidence An American systematic review269 found evidence of efficacy for meditation, relaxation, and other mind-body therapies as adjuncts in the treatment of treatment-related symptoms of cancer, and in improving postsurgical outcomes.

Another US review of nine studies into yoga in cancer270 showed modest improvements in psychological and somatic symptoms, and aspects of physical function such as sleep quality, mood, stress, cancer-related symptoms, and quality of life. These findings were consistent with studies in other patient populations and in healthy people.

Another review of three RCTs and seven uncontrolled trials271 found generally positive results and that Mindfulness-Based Stress Reduction (MBSR) has potential as an intervention for cancer patients.

A randomised controlled trial investigating yoga for breast cancer272 found those participating in an integrated yoga program had significantly reduced hospital perceived stress, anxiety and depression. Post-radiotherapy DNA damage was also slightly reduced.

Another RCT exploring a mind-body-spirit intervention273 comprising meditation, affirmation, imagery and ritual was compared to a cognitive-behavioral (CBT) approach with both interventions resulting in improved quality of life, decreased depression, decreased anxiety and increased sense of spiritual well-being; however the meditation group reported fewer dropouts and higher satisfaction than the CBT group.

Table 2.13.1 summarises the results of significant studies in this field.

Search term: cancer.

269 Astin JA, Shapiro SL, Eisenberg DM, Forys KL. Mind-body medicine: state of the science, implications for practice. J Am Board Fam Pract. 2003 Mar-Apr;16(2):131-47. 270 Bower JE, Woolery A, Sternlieb B, Garet D. Yoga for cancer patients and survivors. Cancer Control. 2005 Jul;12(3):165-71. 271 Smith JE, Richardson J, Hoffman C, Pilkington K. Mindfulness-Based Stress Reduction as supportive therapy in cancer care: SR. J Adv Nurs. 2005 Nov;52(3):315-27. Erratum in: J Adv Nurs. 2006 Mar;53(5):618. 272 Moadel AB, Shah C, Wylie-Rosett J, Harris MS, Patel SR, Hall CB, Sparano JA. RCT of yoga among a multiethnic sample of breast cancer patients: effects on quality of life. J Clin Oncol. 2007 Oct 1;25(28):4387-95. Epub 2007 Sep 4. 273 Targ EF, Levine EG. The efficacy of a mind-body-spirit group for women with breast cancer: a RCT. Gen Hosp Psychiatry. 2002 Jul-Aug;24(4):238-48.

2. Review of the literature

Table 2.13.1. Yoga and meditation for cancer

Study details Summary N= Effect Astin 2003274 A review found considerable evidence of efficacy for meditation, relaxation and n/a 2+ Systematic other mind-body therapies as adjuncts in the treatment of coronary artery review USA disease (eg, cardiac rehabilitation), headaches, insomnia, incontinence, chronic low back pain, disease and treatment-related symptoms of cancer, and improving postsurgical outcomes. There was moderate evidence only of efficacy for mind-body therapies in the areas of hypertension and arthritis. Sood 2007275 A review found promising but not conclusive evidence of the benefit of n/a +/- Review USA relaxation or Tibetan yoga on cancer related fatigue. Bower 2005276 A review of nine studies showed modest improvements in sleep quality, mood, n/a 2+ Review USA stress, cancer-related symptoms and quality of life, consistent with studies in other patient populations and in healthy people showing beneficial effects of yoga on psychological and somatic symptoms, and aspects of physical function. Smith 2005277 A systematic review of Mindfulness-Based Stress Reduction (MBSR) in cancer n/a 1+ Systematic care found three RCTs and seven uncontrolled trials with generally positive review UK results, including improvements in mood, sleep quality and reductions in stress, however methodological limitations precluded drawing firm conclusions. Ornish 2005 The effect of intensive lifestyle changes was investigated in a group of 93 93 1+ Randomised patients with prostate cancer. Patients in the experimental group experienced controlled trial a 4% average decrease in PSA scores while six patients in the control group USA278 required intervention due to progression of the disease, suggesting that intensive lifestyle changes may affect the progression of early, low grade prostate cancer in men. Banerjee An integrated yoga program significantly reduced hospital perceived stress, 68 1+ 2007279 anxiety and depression in breast cancer patients. Post-radiotherapy DNA Randomised damage was also slightly reduced. controlled trial Singapore Moadel 2007280 The effect of a 12-week yoga program, including postures, breathing and 128 1+ Randomised meditation exercises was investigated in women with breast cancer. Of those controlled trial patients not receiving chemotherapy, the yoga group experienced significant USA improvement on measures of quality of life, emotional well-being, social well- being, spiritual well-being, and distressed mood over control. Lower yoga class attendance was associated with increased fatigue.

274 Astin JA, Shapiro SL, Eisenberg DM, Forys KL. Mind-body medicine: state of the science, implications for practice. J Am Board Fam Pract. 2003 Mar-Apr;16(2):131-47. 275 Sood A, Barton DL, Bauer BA, Loprinzi CL. A critical review of complementary therapies for cancer-related fatigue. Integr Cancer Ther. 2007 Mar;6(1):8-13. 276 Bower JE, Woolery A, Sternlieb B, Garet D. Yoga for cancer patients and survivors. Cancer Control. 2005 Jul;12(3):165-71. 277 Smith JE, Richardson J, Hoffman C, Pilkington K. Mindfulness-Based Stress Reduction as supportive therapy in cancer care: SR. J Adv Nurs. 2005 Nov;52(3):315-27. Erratum in: J Adv Nurs. 2006 Mar;53(5):618. 278 Ornish D, Weidner G, Fair WR, Marlin R, Pettengill EB, Raisin CJ, Dunn-Emke S, Crutchfield L, Jacobs FN, Barnard RJ, Aronson WJ, McCormac P, McKnight DJ, Fein JD, Dnistrian AM, Weinstein J, Ngo TH, Mendell NR, Carroll PR. Intensive lifestyle changes may affect the progression of prostate cancer. J Urol. 2005 Sep;174(3):1065-9; discussion 1069-70. 279 Banerjee B, Vadiraj HS, Ram A, Rao R, Jayapal M, Gopinath KS, Ramesh BS, Rao N, Kumar A, Raghuram N, Hegde S, Nagendra HR, Prakash Hande M. Effects of an integrated yoga program in modulating psychological stress and radiation- induced genotoxic stress in breast cancer patients undergoing radiotherapy. Integr Cancer Ther. 2007 Sep;6(3):242-50. 280 Moadel AB, Shah C, Wylie-Rosett J, Harris MS, Patel SR, Hall CB, Sparano JA. RCT of yoga among a multiethnic sample of breast cancer patients: effects on quality of life. J Clin Oncol. 2007 Oct 1;25(28):4387-95. Epub 2007 Sep 4.

2. Review of the literature

Table 2.13.1 (continued)

Study details Summary N= Effect Culos-Reed A seven week pilot study of yoga for breast cancer survivors found significant 38 1+ 2006281 improvement in global quality of life, emotional function, and diarrhoea, and Randomised lesser improvement in emotional irritability, gastrointestinal symptoms, controlled trial cognitive disorganisation, mood disturbance, tension, depression and Canada confusion compared to exercise control. Measures of physical fitness improved significantly in both groups. Cohen 2004282 A program of Tibetan yoga incorporating controlled breathing and 39 1+ Randomised visualisation, mindfulness techniques, and low-impact postures once a week controlled trial for seven weeks in patients with lymphoma reported significantly lower sleep USA disturbance scores and less use of sleep medications. There was no significant difference between yoga and control in measures of intrusion or avoidance, state anxiety, depression, or fatigue. Targ 2002283 A mind-body-spirit intervention comprising meditation, affirmation, imagery 181 1+ Randomised and ritual was compared to a cognitive-behavioral approach with sharing and controlled trial support. Both interventions resulted in improved quality of life, decreased USA depression, decreased anxiety and increased sense of spiritual well-being. Other measures were mixed and not significant bewtween groups. The meditation group showed higher satisfaction and fewer dropouts. Carson 2007284 A pilot study of an eight week Yoga of Awareness program (gentle yoga 12 +/- Clinical trial postures, breathing exercises, meditation, oral presentations and group USA interchange) for women with metastatic breast cancer showed that on the day after a day during which women practised more, they experienced significantly lower levels of pain and fatigue, and higher levels of invigoration, acceptance, and relaxation.

281 Culos-Reed SN, Carlson LE, Daroux LM, Hately-Aldous S. A pilot study of yoga for breast cancer survivors: physical and psychological benefits. Psychooncology. 2006 Oct;15(10):891-7. 282 Cohen L, Warneke C, Fouladi RT, Rodriguez MA, Chaoul-Reich A. Psychological adjustment and sleep quality in a randomised trial of the effects of a Tibetan yoga intervention in patients with lymphoma. Cancer. 2004 May 15;100(10):2253- 60. 283 Targ EF, Levine EG. The efficacy of a mind-body-spirit group for women with breast cancer: a RCT. Gen Hosp Psychiatry. 2002 Jul-Aug;24(4):238-48. 284 Carson JW, Carson KM, Porter LS, Keefe FJ, Shaw H, Miller JM. Yoga for women with metastatic breast cancer: results from a pilot study. J Pain Symptom Manage. 2007 Mar;33(3):331-41.

2. Review of the literature

2.14. Seniors and carers

There was little evidence in the literature of the efficacy of yoga-related interventions for seniors and carers, however, this section of the review is necessary for completeness.

2.14.1. Summary of the evidence Table 2.14.1 summarises the results of studies in this field.

Search terms: dementia, carer, palliative, nursing home, institution, geriatric, elderly.

Table 2.14.1. Yoga and meditation for palliative care, carer health, dementia, and quality of life in geriatric care

Study details Summary N= Effect Howe 2007285 A meta-analysis of 34 RCTs of the benefits of exercise for older people found n/a 2+ Meta analysis UK the greatest effect from walking, balance, co-ordination and functional, muscle strengthening and multiple exercise types. The ability to stand on one leg, reach forward without overbalancing, and walking improved. Cooper 2007286 In a review of anxiety in carers of people with dementia, 24 studies met the n/a +/- Systematic review inclusion criteria but most were found to be inadequate. One study using CBT UK and relaxation was effective in reducing anxiety, while there was preliminary evidence only of the benefit of yoga plus relaxation for carer anxiety. Krishnamurthy A program of yoga for 7 hours 30 minutes weekly comprising postures, 69 1+ 2007287 relaxation techniques, regulated breathing, devotional songs, and lectures Randomised was found to reduce depression symptom scores at three months and six controlled trial months in an institutionalised geriatric population, over an Ayurveda India intervention and control. Hill 2007288 A six-month supported physical activity program (strength training, yoga, or 116 1+ Clinical trial Tai Chi) for older carers found significant improvement for balance, strength, Australia gait endurance, depression, but no change in a measure of carer burden. Curiati 2005289 In elderly patients with optimally treated Congestive Heart Failure (CHF), 19 1+ Randomised listening to a 30 minute meditation tape at home twice a day for 12 weeks controlled trial plus a weekly meeting, reduced sympathetic activation, improved quality of Brazil life and one cardiopulmonary measure. Manjunath The effect of Yoga or Ayurveda on the self-rated sleep in a geriatric 120 1+ 2005290 population over six months found a significant decrease in the time taken to Randomised fall asleep, an increase in the total number of hours slept and in the feeling controlled trial of being rested in the morning based in the yoga group. India Helm 2000291 A study investigating the effect of religious activity including prayer, n/a 1+ Multi centre study meditation and Bible study in the elderly over 6 years found that participants USA who participated in one or more of these activities prior to the onset of impairment of daily living had a survival advantage over those who did not.

285 Howe TE, Rochester L, Jackson A, Banks PM, Blair VA. Exercise for improving balance in older people. Cochrane Database Syst Rev. 2007 Oct 17;(4):CD004963. 286 Cooper C, Balamurali TB, Selwood A, Livingston G. A systematic review of intervention studies about anxiety in caregivers of people with dementia. Int J Geriatr Psychiatry. 2007 Mar;22(3):181-8. 287 Krishnamurthy MN, Telles S. Assessing depression following two ancient Indian interventions: effects of yoga and ayurveda on older adults in a residential home. J Gerontol Nurs. 2007 Feb;33(2):17-23. 288 Hill K, Smith R, Fearn M, Rydberg M, Oliphant R. Physical and psychological outcomes of a supported physical activity program for older carers. J Aging Phys Act. 2007 Jul;15(3):257-71. 289 Curiati JA, Bocchi E, Freire JO, Arantes AC, Braga M, Garcia Y, Guimarães G, Fo WJ. Meditation reduces sympathetic activation and improves the quality of life in elderly patients with optimally treated heart failure: a prospective randomised study. J Altern Complement Med. 2005 Jun;11(3):465-72. 290 Manjunath NK, Telles S. Influence of Yoga and Ayurveda on self-rated sleep in a geriatric population. Indian J Med Res. 2005 May;121(5):683-90. 291 Helm HM, Hays JC, Flint EP, Koenig HG, Blazer DG. Does private religious activity prolong survival? A six-year follow-up study of 3,851 older adults. J Gerontol A Biol Sci Med Sci. 2000 Jul;55(7):M400-5.

2. Review of the literature

2.15. Competitve research funding

Competitive research funding grants can provide another indication of where there is sufficient evidence of efficacy to justify further research. For example, the cancer researchers at MD Anderson Cancer Centre in the USA received funding in 2006 to expand their research on the benefits of Tibetan yoga for the management of side effects related to cancer treatment292. Tibetan yoga involves breathing, physical movements and meditation, with an emphasis on meditation and visualisation. This research will involve a large randomised clinical trial that will assess the physical and psychological benefits of the yoga program, and will specifically examine patient lifestyle factors such as fatigue and sleep, mental health and distress.

At the time of writing, the following studies had received funding from the National Institutes of Health (NIH) in the US293:

Efficacy of Yoga for Self-Management of Dyspnea in COPD. Virginia Carrieri-Kohlman, University of California, San Francisco Yoga as a Treatment for Insomnia. Sat Khalsa, Brigham and Womens’ Hospital Effects of Yoga on Quality of Life during Breast Cancer. Alyson Moadel, Yeshiva University Evaluating Yoga for Chronic Low Back Pain. Karen Sherman, Center for Health Studies Yoga and Peak Flow Rates in Pregnant Asthmatics. Judith Balk, Magee Women’s Health Corp Evaluating Yoga for Chronic Low Back Pain Yoga as a Treatment for Insomnia Yoga: Effect on Attention in Aging and Multiple Sclerosis Yoga for Treating People at Risk for Diabetes or With Both HIV and Depression Yoga for Treating Shortness of Breath in Chronic Obstructive Pulmonary Disease (COPD)

292 University of Texas. MD Anderson Cancer Centre. http://www.cancerwise.org/June_2006/display.cfm?id=FD45F931-3F09- 4C02-B63122B9D027316B. Accessed 15/1/08. 293 National Institutes of Health clinical trials register. http://clinicaltrials.gov/ct2/results?term=yoga. Accessed 15/1/08.

2. Review of the literature

2.16. Contraindications of yoga interventions

No studies have reported harmful effects from yoga interventions. However, it must be noted that there are many yogic practices, which if not performed correctly by an appropriately trained practitioner, have the potential to cause harm.

Yoga postures, by their nature, can be demanding and may cause physical injury. Certain postures are contra-indicated in pregnancy294 and best practice in the yoga teaching profession is currently to advise women not to attend general yoga classes in the first trimester of pregnancy. However, it should be noted that there are also many yoga practices which are entirely safe during this time.

Pranayama also offers many strong and profound techniques which may be distressing or dangerous to untrained practitioners. For example, there is at least one case study in the literature of pneumothorax associated with Kapalabhati pranayama295.

Likewise with meditation, the literature suggests that while meditation may be beneficial for anxiety disorders in general, people with a history of psychosis or personality disorder should seek the advice of their psychiatrist before commencing meditation296. Likewise, meditation may be contra-indicated in depressive illnesses for its introspective nature297. There is also a theoretical risk that meditation could create conditions in the brain conducive to epilepsy298; while on the other hand, it has also been shown to be effective for epilepsy299.

294 Ernst E, Pittler M, Wider B. The Desktop Guide to Complementary and Alternative Medicine, Second Edition, 2006. Mosby Elsevier Press. 295 Johnson DB, Tierney MJ, Sadighi PJ. Kapallabhati pranayama: breath of fire or cause of pneumothorax? A case report. Chest 2004;125:1951–1952. 296 Sethi S, Bhargava S C. Relationship of meditation and psychosis: case studies. Aust NZ J Psychiatry 2003;37:382 297 Ernst E, Pittler M, Wider B. The Desktop Guide to Complementary and Alternative Medicine, Second Edition, 2006. Mosby Elsevier Press. 298 Jaseja H. Meditation may predispose to epilepsy: an insight into the alteration in brain environment induced by meditation. Med Hypotheses 2005;64:464–467. 299 Arias AJ, Steinberg K, Banga A, Trestman RL Systematic review of the efficacy of meditation techniques as treatments for medical illness Journal of Alternative & Complementary Medicine. 12(8):817-32, 2006

2. Review of the literature

2.17. National health priority areas

Given that many of the conditions for which the efficacy of yoga and meditation have been investigated in the scientific literature are also identified as national health priority areas in Australia, it is important to the discussion later in this report to consider the areas of burden on the healthcare system. Therefore, sections 2.17 and 2.18 of this review are included to provide a context for the discussion around the possible benefits or cost savings to Australia of yoga practice, and are not intended to represent an extensive review of the literature.

The following information is taken from the Australian Institute of Health and Welfare (AIHW) Australian Burden of Disease and Injury Study, 1999300.

2.17.1. Measuring years of life lost Australia is 10th in the world for life expectancy at birth, after Japan, Greece, Sweden and Italy. Australian men die on average, six years younger than women (75.6 years for men, 81.3 years for women).

The following seven National Health Priority Areas represent 70% of the total burden of disease (81% of YLL and 57% of YLD) in Australia. YLL is a measure of ‘Years of Life Lost’ while YLD is a measure of ‘Years Lost to Disability’. Each has a specific cost to the community in terms of burden on the healthcare system, and the personal and community burden, for example in personal suffering, lost productivity, and earnings.

1. Cardiovascular health 2. Cancer control 3. Mental health 4. Injury prevention 5. Diabetes mellitus 6. Asthma 7. Arthritis

The AIHW has reported that, “Large health gains can be expected from effective public health interventions in these (National Priority) areas.”

Cardiovascular disease, cancers and injury account for 72% of all YLL. For people over 75 years old, the years of life lost are more from cardiovascular disease, for people less than 75 years old, more from cancer.

Smoking related diseases, like lung cancer and Chronic Obstructive Pulmonary Disease (COPD), are slightly down for men, but rising for women.

In terms of disability, years lost are primarily to mental disorders for both men and women, representing 30% of the non-fatal disease burden to Australia, of which a quarter is attributable to depression. Nervous system and sense organ disorders follow with 16% of the YLD burden; then hearing loss and alcohol dependence/abuse for men, and dementia and osteoarthritis for women.

Another measure, which combines the effect of YLL and YLD, is the DALY (Disability Adjusted Life Years). DALYs are used to better understand the total burden of death, disease and disability in Australia. Currently, men contribute 13% more to DALYs than

300 Australian Institute of Health and Welfare (AIHW). Australian Burden of Disease and Injury Study, 1999. http://www.aihw.gov.au/publications/index.cfm/title/5180. Accessed 10/2/08.

2. Review of the literature

women, primarily through cardiovascular diseases (21%), cancers (19%) and mental disorders (14%). However, mental disorders are predicted to be the number one burden in Australia in 2020.

2.17.2. Risk factors in Australia Smoking is the number one risk factor in Australia, accounting for 12% of the total burden, followed by physical inactivity (7%), high blood pressure (5%), overweight and obesity (4%), and high cholesterol (3%).

The National Heart Foundation of Australia, in its 2003 Position Statement stated, “There is strong and consistent evidence of an independent causal association between depression, social isolation and lack of quality social support and the causes and prognosis of coronary heart disease…furthermore the increased risk contributed by these psychosocial factors is deemed to be of similar order to the more conventional coronary heart disease risk factors such as smoking, dyslipidaemia and hypertension.301”

Therefore, it seems that practices and interventions that address the following risk factors, along with addressing the causes and progression of mental disorders, will have the greatest benefit on the burden of disease and disability in Australia:

Smoking cessation Physical inactivity High blood pressure Overweight and obesity High cholesterol Depression Social isolation

301 Bunker SJ, Colquhoun DM, Esler MD, Hickie IB, Hunt D, Jelinek VM, Oldenburg BF, Peach HG, Ruth D, Tennant CC, Tonkin AM. "Stress" and coronary heart disease: psychosocial risk factors: National Heart Foundation of Australia position statement update. Medical Journal of Australia, 2003. 178(6):272-276.

2. Review of the literature

2.18. Other influences on health, well-being and longevity

2.18.1. Social capital To better understand the concept of social isolation and lack of quality social support as a risk factor for illness and disease, a detailed review conducted by Helliwell and Putnam in 2004, found that ‘social capital’ is strongly linked to subjective well-being302. This capital includes marriage and family, connectedness to friends, neighbours and workmates, individual and collective civic engagement, trust and trustworthiness.

Breaking this down further, the authors reported that higher levels of subjective well-being, life satisfaction and happiness were associated with:

Age group; younger people (less than 35 years old) and older people (over 65 years old) were more satisfied with their lives, assuming good health in the older age group; Gender; to some extent by geographic region, eg; women in Scandinavia, Asia and North America reported slightly more life satisfaction than men; whereas the opposite was true in the countries of the former Soviet Union; Income; especially seen as relative to the income of others in society; Education; through a positive effect on health status and in turn, on sense of well-being; Employment; and conversely, a lower sense of well-being in unemployment; Marital status; being married was shown to increase both life satisfaction and happiness equally in males and females; Family; and higher levels of interaction with extended family members; Faith; and frequency of church attendance, believed to increase social capital in other areas such as trust, connectedness and civic engagement; Connectedness; through frequency of interaction with friends, family and neighbours, in that order of effect; Community involvement; usually as a factor of one’s own level of participation; Trust; through higher levels of trust in others, or living in a trusting environment

On an individual (personality) level, the strongest predictors of subjective well-being were found to be optimism and self-esteem.

2.18.2. Religiosity, spirituality and meaning In another review of the literature, frequency of religious attendance, private religious involvement, and relying on one's religious beliefs as a source of strength and coping were found to have a protective effect against mental and physical illness, improving how people cope with mental and physical illness, and facilitating recovery from illness303. That review specifically focused on involvement in organised religion, rather than non-religious spirituality or other forms of faith, and suggested that family doctors could improve patient outcomes by encouraging patients to utilise the resources within the patient’s preferred religious tradition.

302 Helliwell JF and Putnam RD. The social context of well-being. Philos Trans R Soc Lond B Biol Sci. 2004 September 29; 359(1449): 1435–1446. http://journals.royalsociety.org/content/nrf2rbd3dx3tyvtj/. Accessed 14/2/08. 303 Matthews DA, McCullough ME, Larson DB, Koenig HG, Swyers JP, Milano MG. Religious Commitment and Health Status. A Review of the Research and Implications for Family Medicine. Arch Fam Med. 1998;7:118-124. http://archfami.ama- assn.org/cgi/content/full/7/2/118. Accessed 14/2/08.

2. Review of the literature

Religiosity can further be understood as ‘extrinsic’, representing the trappings and behaviours of a religion, or ‘intrinsic’, being a strong personal commitment to a religious belief. In turn, intrinsic religiosity relates closely to ‘spirituality’, which while different and similar to religiosity, can be understood as a sense of connection to something greater than oneself. Intrinsic religiosity seems to be more protective for mental health than extrinsic religiosity304.

Interestingly, Sigmund Freud described religion as “an obsessional neurosis,” and the search for meaning as “regression to primary narcissism,305”; while Carl Jung saw religion as central to the human experience, stating, “Deviation from the truths of the blood begets neurotic restlessness. Restlessness begets meaninglessness, and the lack of meaning in life is a soul- sickness whose full extent and full import our age has not yet begun to comprehend.306” This fundamental difference in outlook was reportedly one of the reasons Freud and Jung parted company.

Religious commitment has also been associated with reduced incidence of depression and suicide307, quicker recovery from depressive illness308, reduced incidence of drug and alcohol abuse309 and reduced risk for conditions such as hypertension, heart disease and cancer310,311,312,313.

Finally, all-cause mortality was found to be significantly reduced, and life expectancy increased by seven years (to 82 years) for regular churchgoers314,315. Clearly, some of the protective effect of religiosity and church-going extends to people who hold non-religious spiritual beliefs, most probably as a factor of level of commitment to a belief system and level of social interaction and connectedness as a result of holding that belief system.

304 Reed P. Spirituality and wellbeing in terminally ill hospitalised patients. Res Nurs Health 1987;9:35-41. 305 Freud.org.uk. http://www.freud.org.uk/religion.html. Accessed 27/2/08 306 C.G. Jung. Psychology, pp. 136-137. 307 Gartner J, Larson D, Allen G. Religious commitment and mental health: a review of the empirical literature. J Psychol Theol 1991;19:6-25. 308 Koenig H, George L, Perterson B. Religiosity and remission of depression in medically ill older patients. American Journal of Psychiatry 1998;155:536-42. 309 Larson D., Wilson W. The religious life of alcoholics. Southern Medical Journal 1980;73:723-7. 310 Fraser G., Sharlik D. Risk factors for all-cause and coronary heart disease mortality in the oldest old: the Adventist’s Health Study. Archives of Internal Medicine 1997;157(19):2249-58. 311 Levin J, Vanderpool H. Is frequent religious attendance really conducive to better health? Toward an epidemiology of religion. Soc Sci Med. 1987;24:589-600. 312 Kune G, Kune S, Watson L. Perceived religiousness is protective for colorectal cancer: data from the Melbourne Colorectal Cancer Study. Journal of the Royal Society of Medicine 1993;86:645-7. 313 Craigie F, Larson D, Liu I. References to religion in the Journal of Family Practice: dimensions and valency of spirituality. J Fam Pract 1990;30:477-80. 314 Hummer R., Rogers R., Nam C. et al. Religious involvement and U.S. adult mortality. Demography 1999;36(2):273-85. 315 Clark K., Friedman H., Martin L. A longitudinal study of religiosity and mortality risk. Journal of Health Psychology 1999;4(3):381-91.

2. Review of the literature

2.18.3. Calorie restriction Longevity has been associated with calorie restriction, as well as to public health and sanitation, reliability and quality of food supply, housing and to a lesser extent, medical advances316. Calorie restriction is largely a matter of not eating excess and empty calories. Conversely, the genesis and progression of many conditions including heart disease, cancer, and diabetes is associated with over-consumption317,318.

2.18.4. Vegetarianism The health benefits of vegetarianism are well established in the literature. The China Project on Nutrition, Health and Environment, found significantly lower blood cholesterol levels and a low incidence of heart disease, cancer, obesity, diabetes, and Osteoporosis in rural Chinese communities319. The rural Chinese diet is largely vegetarian or vegan, with less total protein, less animal protein, less total fat and animal fat, and more carbohydrate and fibre than the typical Western diet.

Similarly, the Oxford Vegetarian Study found that vegans had lower total and LDL cholesterol than meat eaters, while vegetarians and fish eaters had intermediate and similar values. Meat and cheese consumption were associated with higher cholesterol while dietary fiber intake was associated with lower cholesterol in both men and women. After a 12 year follow-up, all-cause mortality was about half that of the population of England and Wales320.

Another review of six studies in North America and Europe found that a low meat intake was associated with a decrease in risk of death and an increase in life expectancy321.

316 Roth GS, Lane MA, Ingram DK, Mattison JA, Elahi D, Tobin JD, Muller D, Metter EJ.. Biomarkers of caloric restriction may predict longevity in humans. Science. 2002 Aug 2;297(5582):811. http://www.sciencemag.org/cgi/content/full/297/5582/811. Accessed 14/2/08. 317 Weinert BT, Timiras PS. Invited review: Theories of aging. J Appl Physiol. 2003;95(4):1706-16. 318 Anisimov VN. Insulin/IGF-1 signaling pathway driving aging and cancer as a target for pharmacological intervention. Exp Gerontol. 2003;38(10):1041-9. 319 Campbell, T. Colin (2006). The China Study:The Most Comprehensive Study of Nutrition Ever Conducted and the Startling Implications for Diet, Weight Loss and Long-term Health. Benbella Books. 320 Appleby PN, Thorogood M, Mann JI, Key TJA. The Oxford Vegetarian Study. Am J Clinical Nutrition, Vol. 70, No. 3, 525S- 531S, Sept 1999. http://www.ajcn.org/cgi/content/full/70/3/525S?ck=nck. Accessed 10/3/08. 321 Singh PN, Sabaté J, Fraser GE. Does low meat consumption increase life expectancy in humans? Am J Clinical Nutrition, Vol. 78, No. 3, 526S-532S, Sept 2003. http://www.ajcn.org/cgi/content/full/78/3/526S. Accessed 10/3/08.

2. Review of the literature

2.18.5. Perception, sleep Perception has also been shown to play a significant role in longevity. Older people with more positive self-perceptions of aging, measured up to 23 years earlier, lived 7.5 years longer than those with less positive perceptions, even after adjusting for age, gender, socio- economic status, loneliness, and functional health322. This compares favourably with years of life gained through having lower blood pressure (4 years), lower cholesterol (4 years), and lower BMI, not smoking and exercise (all 1-3 years).

A series of studies in the US identified the following contributing factors for poorer health and shorter life323, 324,325.

Alcohol abuse Smoking Lack of or little physical activity Obesity Sleeping fewer or more than 7-8 hours Eating between meals Not eating breakfast Lack of social connectedness Lack of personal relationships

These are similar to the risk factors for the Australian National Health Priority Areas described earlier, with the addition of skipping breakfast, eating between meals, and lack of sleep.

Another review also identified education, ‘mature coping mechanisms’ and depression as significantly predictive of being a “happy-well” person or a “sad-sick” person326. Happiness and a wellness attitude were strongly associated with longer and better life, independent of other lifestyle variables.

322 Levy BR. Slade MD. Kunkel SR. Kasl SV. Longevity increased by positive self-perceptions of aging. Journal of Personality & Social Psychology 2002;83(2):261-70. http://www.ncbi.nlm.nih.gov/pubmed/12150226 Accessed 14/2/08. 323 Human Population Laboratory, California Department of Public Health. Alameda County Population, 1965. Series A, No. 7, 1966. 324 Wiley J, Camacho T. Lifestyle and future health: evidence from the Alameda County Study. Preventive Medicine 1980;9:1- 21. 325 Seeman T, Kaplan G, Knudsen L et al. Social network ties and mortality among the elderly in the Alameda County Study. American Journal of Epidemiology 1987;126:714-23. 326 Valliant G, Mukamal K. Successful aging. American Journal of Psychiatry 2001;158(6):839-47.

2. Review of the literature

2.19. Handedness, nasal airflow and brain hemisphericity

Finally, to provide a context for a discussion about handedness and yoga later in this report, the following represents a brief review of the relevant literature (one of the exploratory questions canvassed in the yoga survey was handedness).

About 10% of humans are thought to be left-handed327 with men slightly more likely to be left-handed than women328. A British study in the 70s found that around 11% of men and women aged 15-24 were left-handed, compared to just 3% in the 55-64 age group329, suggesting that the social stigma associated with left-handedness is gradually being resolved. If societal pressure to conform to right-handedness could be removed completely, it is thought that about one in six humans (about 15%) would be left-handed330. The Australian Bureau of Statistics (ABS) found recently that 17% of school children in Queensland were left-handed which seems to confirm this trend331. No reliable data was found on the handedness of Australian adults.

No literature was found in relation to handedness and yoga. However, it is popularly believed that left-handedness is linked to right brain dominance, and that left-handed people as a group have historically produced an above average quota of creative high achievers332, much like the popular battle-of-the-sexes debate that women are more right-brained than men. As a selective example, male left-handers have included Michelangelo, Leonardo da Vinci, Picasso, Raphael, Isaac Newton, Einstein and Beethoven333.

A recent study found that left-handed subjects were better at coordinating both sides of their brain than right-handed subjects334. Around the same time, a paper published in the journal of Neuropsychology agreed that left-handers and right-handers had differences in their corpus callosum (CC), the nerve fibres that connect the two hemispheres of the brain, allowing left-handers faster transfer of information between the halves of the brain, and better handling of multiple stimuli335.

If so, left-handed men may have something in common with women. Recent studies have fuelled the debate, finding that the splenium (the posterior and thickest end of the CC) is larger in women and the genu (the anterior end of the CC) is larger in men336. Another study found greater volume and signal intensity and decreased fractional anisotropy (a measure of directional organisation) in the CC of women337.

327 A Left hand Turn Around the World. David Wolman. Da Capo Press, 2005. http://www.david-wolman.com/. Accessed 1/2/08. 328 Raymond M, Pontier D, Dufour AB, Møller AP. Frequency-dependent maintenance of left handedness in humans. Proc Biol Sci. 1996 Dec 22;263(1377):1627-33. 329 Fleminger J J, Dalton R, Standage K. Age as a factor in the handedness of adults. 1977. Neuropsychologia 15: 471-473. 330 Steele J, Mays S. New findings on the frequency of left- and right-handedness in medieval Britain. 1995. http://web.archive.org/web/20021208040702/http://www.soton.ac.uk/~tjms/handed.html. Accessed 1/2/08. 331 Australian Bureau of Statistics, Media Release. http://www.abs.gov.au/ausstats/[email protected]/mediareleasesbyReleaseDate/E99BDF16A33804EDCA2571BE0079A005?OpenDocume nt. Accessed 1/2/08. 332 Right Hand Left Hand official website. http://www.righthandlefthand.com/. Accessed 1/2/08. 333 Holder, M. K. Handedness and Lateralization research. http://www.indiana.edu/~primate/. Accessed 1/2/08. 334 British Broadcasting Corporation News. Left-handers 'think' more quickly. http://news.bbc.co.uk/1/hi/health/6212972.stm. Accessed 1/2/08. 335 Cherbuin N, Brinkman C. Hemispheric interactions are different in left-handed individuals. Neuropsychology. 2006 Nov;20(6):700-7. 336 Dubb A, Gur R, Avants B, Gee J. Characterization of sexual dimorphism in the human corpus callosum. Neuroimage. 2003 Sep;20(1):512-9. 337 Shin YW, Kim DJ, Ha TH, Park HJ, Moon WJ, Chung EC, Lee JM, Kim IY, Kim SI, Kwon JS. Sex differences in the human corpus callosum: diffusion tensor imaging study. Neuroreport. 2005 May 31;16(8):795-8.

2. Review of the literature

Another recent study found a link between corpus callosum size and hemisphericity. Right brain-oriented individuals of either sex had significantly larger corpus callosum than left brain-oriented individuals338.

The nasal cycle, which alternates dominance between the right and left nostril approximately every 90 minutes, is also known to index brain hemisphericity and in the same way, a deviated nasal septum may prevent nasal cycling339. Single nostril breathing, whether by accident of nature or by using a specific breathing technique, has been shown to increase relative EEG (electroencephalogram) amplitudes in the opposite hemisphere of the brain. In the left hemisphere, this stimulation increases sympathetic activity while right hemisphere stimulation increases parasympathetic activity of the autonomic nervous system. Corresponding changes in measures of sympathetic activation include changes in heart rate, and in systolic and diastolic blood pressure340.

Likewise, alternate nostril breathing has been shown to have a balancing effect on the autonomic nervous system341,342,343. Other studies have suggested links between breathing through a particular nostril and measures of cognitive performance (spatial/right hemisphere and verbal/left hemisphere) and motor skills344,345,346,347.

A study of right-handed men and women sheds further light. In right-handed men, both left and right forced uni-nostril breathing signigicantly increased systolic blood pressure and heart rate with no change in diastolic blood bressure. In right-handed women, right nostril breathing increased both systolic and diastolic blood pressure, but left nostril breathing slightly reduced both, suggesting a gender differential in the effect of nostril airflow on the autonomic nervous system348.

338 Morton BE, Rafto SE. Corpus callosum size is linked to dichotic deafness and hemisphericity, not sex or handedness. Brain Cogn. 2006 Oct;62(1):1-8. Epub 2006 May 4. 339 Backon J, Negeris B, Kurzon D, Amit-Chochavi H. A straight nasal septum and right unilateral hypertrophied inferior nasal turbinate, a very rare anatomical phenomenon, in skilled language translators: relevance to anomalous dominance, brain hemisphericity and second language acquisition. Int J Neurosci. 1991 Jun;58(3-4):157-63. 340 Backon J, Matamoros N, Ticho U. Changes in intraocular pressure induced by differential forced unilateral nostril breathing, a technique that affects both brain hemisphericity and autonomic activity. A pilot study. Graefes Arch Clin Exp Ophthalmol. 1989;227(6):575-7. 341 Stancák A Jr, Kuna M. EEG changes during forced alternate nostril breathing. Int J Psychophysiol. 1994 Oct;18(1):75-9. 342 Jain N, Srivastava RD, Singhal A. The effects of right and left nostril breathing on cardiorespiratory and autonomic parameters. Indian J Physiol Pharmacol. 2005 Oct-Dec;49(4):469-74. 343 Srivastava RD, Jain N, Singhal A. Influence of alternate nostril breathing on cardiorespiratory and autonomic functions in healthy young adults. Indian J Physiol Pharmacol. 2005 Oct-Dec;49(4):475-83. 344 Raghuraj P, Telles S. Right uninostril yoga breathing influences ipsilateral components of middle latency auditory evoked potentials. Neurol Sci. 2004 Dec;25(5):274-80. 345 Telles S, Raghuraj P, Maharana S, Nagendra HR. Immediate effect of three yoga breathing techniques on performance on a letter-cancellation task. Percept Mot Skills. 2007 Jun;104(3 Pt 2):1289-96. 346 Naveen KV, Nagarathna R, Nagendra HR, Telles S. Yoga breathing through a particular nostril increases spatial memory scores without lateralized effects. Psychol Rep. 1997 Oct;81(2):555-61. 347 Jella SA, Shannahoff-Khalsa DS. The effects of unilateral forced nostril breathing on cognitive performance. Int J Neurosci. 1993 Nov;73(1-2):61-8. 348 Dane S, Calişkan E, Karaşen M, Oztaşan N. Effects of unilateral nostril breathing on blood pressure and heart rate in right- handed healthy subjects. Int J Neurosci. 2002 Jan;112(1):97-102.

2. Review of the literature

In yogic literature, ‘swara’ means ‘sound’ or ‘cycle’ and can often relate to music, or in the case of yogic breathing it relates to the rhythm of inhaling and exhaling in harmony (cycle) with certain biological and/or environmental rhythm, as well as brain wave patterns. Swara can also mean flow, as in ebb and flow.

In the same way, the term swara sometimes refers to uni-nostril, and ‘udaya’ to alternate nostril breathing; both long practised and documented for their health effects349. Likewise, the effect of yoga postures on nasal airflow is documented. In one study, postures such as Halasana, Paschimottanasana, Dhanurasana, Ustrasana and Padahastasana, were said to equalise airflow in the nostrils; while other postures such as Gomukasana, Ardhamatsyendrasana and Sarvangasana, were found not to fully balance the nasal airflow, but to provide maximum decongestion to the blocked nostril350.

Yoga is a largely symmetrical discipline, with attention given to balancing each posture with a counter-posture, and in the more dynamic styles of yoga, performing largely symmetrical vinyasa (flowing sequences of postures).

To explain further, it is anecdotally believed in yoga that a symmetrical vinyasa sequence, such as Salute to the Sun (Surya Namaskar), will help balance nasal dominance. While unproven and perhaps a yogic myth, this is not as unusual as it may first appear given that a yoga danda (crutch) when placed under the armpit pressing on the axilla helps to open the nostril on the other side, and lying in a lateral recumbent position will increase the airflow in the nostril on the upper side351.

Certainly if Surya Namaskar is practised aerobically, it will stimulate the sympathetic nervous system and right nostril activity as would other forms of exercise due to cardiac stimulation, however if practised slowly, it may have more parasympathetic and left nostril effect. While the effects might be able to be explained in neurophysiological terms, for example alterations of balance in the autonomic nervous system brought about through postural reflexes which affect respiratory and circulatory functions, the exact mechanisms, however, are generally unclear.

349 Gore M. The Nasal Cycle – A review in relation to yogic literature and scientific research. Yoga Mimamsa Vol XXX, No 2&3 pp 60-74. April 1991. 350 Gore M. Influence of Asanas on the Nostril Dominance. Yoga Mimamsa Vol XXXVI, No 1 pp19-25. April 2004. 351 Gore M. The Nasal Cycle – A review in relation to yogic literature and scientific research. Yoga Mimamsa Vol XXX, No 2&3 pp 60-74. April 1991.

3. Methodology

3.1. Rationale

The rationale for this project was that while there was considerable research into the effectiveness of yoga for various medical conditions, little or no data existed on the actual practice of yoga in Australa or elsewhere. It was thought that a comprehensive study of the practice of yoga in Australia would be beneficial to yoga teachers, yoga practitioners, healthcare professionals and the general public.

Yoga teachers, for example, would benefit from having access to data describing the characteristics and yoga practice of their students; their lifestyle choices, the perceived benefits of their practice, and the causes of yoga-related injuries, amongst other things.

The same information would be useful to people who practice yoga to better understand their discipline, and to healthcare practitioners in informing their decisions to suggest yoga or refer patients to yoga, and to the general public.

The possibility of conducting a survey of a statistically representative sample of the Australian population was considered, but with a national yoga participation rate of only about 3% (from the ABS and ERASS data discussed earlier), it was thought that this would require a prohibitively large sample and therefore considerable expense, in order to achieve sufficient numbers of respondents in sub groups of the data, for example, to achieve sufficient numbers of each gender (especially of males given the low male participation rate), and in each of the main styles of yoga to enable meaningful cross tabulation of variables in the data.

It was thought that the advantages of conducting a survey of existing yoga practitioners would far outweigh the disadvantage of the lack of a denominator, that is, the lack of information as to the characteristics of non-practitioners or non-responders. It was also thought that the inability to determine a ‘response rate’, being the ratio of responders to non-responders would not be material given the nature of the research questions and the opportunistic nature of the sample, that is in order to the motivated to complete the survey, participants could be assumed to be pro-yoga, creating a systematic bias.

However, in making the decision to conduct a survey of existing yoga practitioners, it was considered important to ensure widespread national recruitment if the results were to have any generalisability to all yoga practice in Australia. Other potential sources of bias would be closely monitored, such as recuitment through certain styles of yoga and teacher associations and groups.

3. Methodology

3.2. Research Questions

A literature search was undertaken in July 2004 and repeated in January 2008, to locate information relating to participation in yoga, the practice of yoga and the effectiveness of yoga, both in Australia and overseas.

As described earlier in this document, some Australian and overseas participation data was found. No Australian practice data was found, and very little overseas. A considerable body of effectiveness research was found in overseas studies, but little in Australia.

Therefore, the primary research ‘question’ was to describe yoga in Australia; to conduct a wide-ranging investigation into the practice of yoga in Australia by means of a national survey.

A process of consultation with the yoga teaching profession, complementary healthcare associations and other contributors such as senior yoga figures and medical doctors took place over 12 months between 2004 and 2005 in order to receive input as to what questions should be asked in the survey, and to test and ‘troubleshoot’ the proposed questions.

The resulting questions were categorised into groupings, summarised as follows:

Demographic and socio-economic characteristics of people who practice yoga Practice characteristics Dietary and lifestyle choices Perceived health and medical benefits of yoga practice Characteristics of practice of yoga teachers Characteristics of yoga-related injuries Subjective experience (Flow) state in yoga

Secondary research questions would arise from investigation and cross tabulation of the variables in the data and with reference to the literature review, such as:

What differences can be identified from the data? E.g. o By style of yoga o By gender o By other variables of interest, e.g. right or left handedness

What are the possible effects of yoga practice over time? E.g. o On spiritual orientation o On vegetarianism o On non-smoking o On non-alcohol consumption o On other physical activity

What are the possible benefits or cost savings to Australia of yoga practice?

3. Methodology

3.3. Justification for conducting a web-based survey

In 2002, Australia had the seventh highest rate of household internet connections amongst OECD countries352, with 50% and 40% of metropolitan and rural households respectively having access to the internet353. It was thought that household internet access would have increased further by 2005.

It was decided that a paper-based survey would be prohibitively expensive, especially in respect of production, printing, handling, mailing, and data entry. Further, the advantages of conducting a web-based survey were considered to outweigh any disadvantages. There was no funding available for this research and therefore it was also a pragmatic decision to conduct a web-based survey.

3.4. Potential for web-based survey bias

Disadvantages of conducting a web-based survey were identified as:

It may exclude people, or groups of people, without convenient access to the internet, therefore creating potential bias in the results towards the demographic and socio-economic characteristics of households connected to the internet (e.g. employed city dwellers) It may disadvantage people who prefer not to (or who are unable to) use a computer, email, or the internet therefore creating a potential bias in the results towards the characteristics of technologically-minded people (e.g. those in the younger age groups).

To attempt to reduce the impact of these identified disadvantages on the representative nature of the sample, it was advised in mailings to yoga schools and teachers that a paper- based version of the survey would be mailed on request. The survey form was also made available for download on the website, and teachers were encouraged to print out the survey for students who did not have internet access.

However, other than as mentioned above, uptake of the paper-based survey was not actively encouraged, due to the additional cost this would have generated. It was interesting to note that despite the availability of the paper-based survey, only 24 paper surveys were returned by participants.

Other potential sources of bias are discussed later in ‘Strengths and weakness of this study’.

352 Organisation for Economic Co-operation and Development. Science, Technology and Industry Scoreboard 2003, Towards a knowledge-based economy. http://www.oecd.org. Accessed 1/2/05. 353 Australian Bureau of Statistics. Household Use of Information Technology, Australia (cat. no. 8146.0).

3. Methodology

3.5. Advantages of conducting a web-based survey

Advantages of a web-based survey were identified as:

Cost effective Ability to reach large numbers of potential participants Ability to screen for data manipulation, e.g. multiple responses from one login or email address, including IP address, and country of origin checking Ability to dynamically direct participants to the next appropriate question or to the next section of the survey, depending on answers to previous questions Ability to validate responses in real time, enhancing data integrity Survey participants would be able to exit and resume the survey, potentially enhancing completion rates Ability to follow-up incomplete responses to the survey by email Ability to stay in touch with survey participants by email to encourage them to continue to invite other potential survey participants Ability to create an online ‘community’ website by promoting yoga related news and events, and supporting other yoga related research The online community created by the survey would be able to continue after the survey was completed

3.6. Challenges in conducting a national web-based survey of yoga

To design a survey instrument broadly representative of, and appropriate to, all styles and traditions of yoga in Australia To design a custom website to administer the survey with additional content such as news, articles and research to interest visitors To ensure appropriate collection and safeguarding of personal information and survey data To ensure the integrity of survey data collected To design a marketing, promotional and communication strategy which would generate a large national response To locate yoga teachers, invite them to participate, to tell other yoga teachers, and to actively encourage their students to participate To motivate people who practice yoga and meditation to visit the website To motivate website visitors to register for the survey by validating their email address and then to spend considerable time completing the survey To motivate website visitors to subscribe to the email newsletter (to enable follow- up) and to use the ‘tell a friend’ form on the website To motivate those who had subscribed to the email newsletter but not registered for the survey, or who had commenced but not completed the registration process, or who had only partially completed the survey, to return to the website again

3. Methodology

3.7. Design of the survey instrument

Initial inspiration for the survey questions was taken from other yoga studies identified in the literature review. Senior figures in the yoga profession, representatives of the various yoga teacher associations and groups, medical doctors and experts in yoga philosophy, techniques and meditation were also asked to provide input as to what questions should be canvassed by the survey.

Reference was also made to numerous Australian Bureau of Statistics reports in order to establish appropriate answer groupings for ease of comparison especially in respect of State of residence354, age group355, Rural, Remote and Metropolitan Areas (RRMA) classification356, another ABS measure of remoteness357,358, physical activity359, religious orientation360,361,362 and rurality363,364.

Issues of psychometric validity of the survey instrument, such as face validity and content validity were considered. Face validity, that is whether a question ‘looks valid’ to the respondents who read it and to the researchers who decide on its use, was considered to be achieved through the extensive process of peer review, pilot testing and troubleshooting.

However content validity, that is the extent to which a measure represents all facets of a given social construct, was acknowledged to be compromised in some instances in favour of creating a survey instrument of manageable size and an enjoyable experience for the respondent.

For example, in designing the question about perceptions of quality of life, it was decided that it would be sufficient to achieve an answer the research question, to divide quality of life into five domains (physical, mental, emotional, spiritual and relationships) and to measure responses to these domains on a seven point scale in a single question, rather than to use a

354 Australian Bureau of Statistics. Australian Demographic Statistics March 2006. http://www.abs.gov.au/AUSSTATS/[email protected]/ProductsbyReleaseDate/00059D8B79D7FF66CA25723C000E8DB2?OpenDocument. Accessed 6/1/08. 355 Australian Bureau of Statistics. Census 2006. 20680-Age by Sex-Australia. http://www.censusdata.abs.gov.au/ABSNavigation/prenav/ViewData?action=404&documentproductno=0&documenttype=Detail s&order=1&tabname=Details&areacode=0&issue=2006&producttype=Census%20Tables&javascript=true&textversion=false&n avmapdisplayed=true&breadcrumb=TLPD&&collection=Census&period=2006&productlabel=Age%20by%20Sex&producttype= Census%20Tables&method=Place%20of%20Usual%20Residence&topic=Age%20&. Accessed 6/1/08. 356 Australian Institute of Health and Welfare. Rural, Remote and Metropolitan Areas (RRMA) classification. http://www.aihw.gov.au/ruralhealth/methodology/rrma.cfm. Accessed 6/1/08. 357 Australian Bureau of Statistics. National Regional Profile 2000-2004: Australia. http://www.abs.gov.au/AUSSTATS/[email protected]/Latestproducts/0Population/People12000- 2004?opendocument&tabname=Summary&prodno=0&issue=2000-2004&num=&view=. Accessed 6/1/08. 358 Australian Bureau of Statistics. 4613.0 - Australia's Environment: Issues and Trends, 2006. http://abs.gov.au/AUSSTATS/[email protected]/Latestproducts/35DDB675E2847593CA257234001F50A6?opendocument. Accessed 6/1/08. 359 Australian Bureau of Statistics. Participation in Sport and Physical Activities, Australia. Cat 4177.0 Accessed 4/1/05. 360 Australian Bureau of Statistics. Australian Standard Classification of Religious Groups. Cat 1266.0. http://www.ausstats.abs.gov.au/ausstats/subscriber.nsf/0/A96B30100714479CCA2570D70013166F/$File/12660_2005.pdf. Accessed 4/1/05. 361 Australian Bureau of Statistics. Census Classifications. Religion – RELP. 3/7/96. http://www.abs.gov.au/Ausstats/[email protected]/0/AD25AA55EB7FDC75CA25697E0018FD84?opendocument. Accessed 4/1/05. 362 Adherents.com. http://www.adherents.com/. Accessed 4/1/05. 363 The Rural, Remote and Metropolitan Area (RRMA) classification system. http://www.health.gov.au/internet/wcms/publishing.nsf/Content/health-workforce-bmp. Accessed 4/1/05. 364 Australian Institute of Health and Welfare. Rural, regional and remote health: a guide to remoteness classifications. http://www.aihw.gov.au/publications/index.cfm/title/9993. Accessed 4/1/05.

3. Methodology

more extensive validated psychological construct such as the Assessment of Quality of Life (AQoL) questionnaire365.

It was thought that using the more rigourous quality of life measure, would cause the survey to become too long and onerous to complete, therefore impacting unfavourably on completion rates and word of mouth recruitment. However, it was also thought that the results of the quality of life question would likely inform future research, at which time it might be considered appropriate to use the more rigourous construct.

The various drafts of the survey questions were presented to a number of focus groups of yoga teachers (see Acknowlegements) for pilot testing, feedback and troubleshooting over a number of months.

The final draft of the questionnaire is shown in Appendices 2-28.

365 Hawthorne, Richardson, et al. (1999). The Assessment of Quality of Life (AQoL) instrument: a psychometric measure of health-related quality of life. Qual Life Res 8(3): 209-24. http://www.buseco.monash.edu.au/centres/che/pubs/tr12.pdf. Accessed 15/2/08.

3. Methodology

3.8. Design of the website

As shown in Figure 3.8.1, a comprehensive information website was designed to support and host the survey, providing articles and news items, along with details of other yoga-related research to provide interest for visitors. Visitors to the website were encouraged to join the ‘on-line community’ by subscribing to a monthly email newsletter.

Figure 3.8.1. Home page of website designed to host the survey

Popular web-based survey solutions such as Survey Monkey366 and open source software such as PHP Surveyor367 were considered but not thought to be suitable. Primary considerations were:

Email validation registration system to qualify participants Control of where and how the data was stored Allowing participants to logout and login again Desire to develop an ongoing online community

These considerations seemed to require a custom built solution. Using HTML, PHP and MySQL, a registration, validation and login system was built to deliver the questionnaire, as shown in Figure 3.8.2 below. Questions were grouped into modules, which were served dynamically based on the answers to certain initial questions. Data validation scripts were also written to enhance the quality of data in key questions. A number of people tested the survey prior to it going ‘live’.

366 Survey Monkey. http://www.surveymonkey.com/. Accessed 1/11/04. 367 Lime Survey. http://www.limesurvey.org/ (formerly PHP Survey). Accessed 1/11/04.

3. Methodology

Figure 3.8.2. Registration/login page of survey

3.9. Plain language statement and privacy policy

A plain language statement and privacy policy (Appendix 29), regarding the rights of survey participants and the collection of personal information on the website, was prepared and submitted for ethics approval with the questionnaire and the project brief.

3.10. Ethics approval

Ethics approval was granted by the RMIT University Human Research Ethics Committee in May 2005. Data collection commenced on 17 June 2005 and ceased on 6 January 2006.

3. Methodology

3.11. Recruitment

A wide range of recruitment techniques were used, including the following key elements:

Teacher associations and groups Teacher associations such as those mentioned earlier (YTAA, IYTA, BKSIYAA, SYTA, YIDL) were contacted, inviting consultation in the design of the survey questions and seeking practical support in reaching their members. Direct contact with members was provided by YTAA, BKSIYAA and SYTA (about 1500 teachers in total). EMP Industrial368 (a wholesaler of yoga mats and accessories) also provided contact with its national client list of yoga mat buyers (another 1500 people). Other associations provided indirect contact with their members via their member newsletters (YTISA, IYTA).

Direct mail and email The online versions of the national Business White Pages and Yellow Pages were searched for ‘yoga’, ‘pilates’ and in the yoga category in November 2004. A database of yoga schools and teachers was created from the search results shown in Table 3.11.1 below.

Table 3.11.1. Business listings for yoga in the online national White & Yellow Pages

State Yellow Pages White Pages TOTAL National MetroRegional ACT 38 11 11 60 NSW 336 97 53 486 NT 10 3 3 16 QLD 192 23 28 243 SA 61 24 1 86 TAS 11 3 2 16 VIC 263 85 17 365 WA 57 30 2 89 TOTAL 968 276 117 1361

Duplication was manually removed, resulting in about 900 unique entries. A Google search was also conducted for Australian yoga websites to find the contact details of yoga schools and teachers. As a result, a database of more than 2000 yoga schools and teachers across Australia was created. Direct mail and email was used to invite these people to complete the survey and to encourage their students to also participate. A number of mailings were conducted before and during the survey period. Invitation postcards were included in the letters.

368 EMP Industrial. http://www.empind.com.au/. Accessed 15/2/08.

3. Methodology

Invitation postcards About 40,000 postcards (Figure 3.11.2 and Appendix 33) were distributed to yoga teachers and yoga schools in batches of 10–160 for distribution to their students. Teachers were advised in the mailings, and later in the email newsletter, that they could order more postcards on the website (Appendix 31). A total of 187 website orders were received for more batches of postcards to be mailed during the survey period.

The postcard invites the reader to visit the survey website, with the message, Write your name in Yoga History.

Figure 3.11.2. Front and back of the invitation postcard

Meetings and conferences Numerous meetings, conferences and speaking engagements around the country were attended to raise and maintain awareness of the yoga survey project in the yoga community, as shown in the project timeline in Section 3.17 with examples of the academic posters displayed in Appendices 34 and 65.

Mainstream media RMIT University Media Department issued three press releases during and immediately after the survey period resulting in a number of radio interviews and press articles. In addition, articles were written and submitted for publication in holistic magazines such as Australian Yoga Life and Living Now. Media generated is shown in the project timeline in Section 3.17 with examples in Appendices 38-70.

Email newsletter A monthly email newsletter was sent to thousands of website subscribers and survey participants, providing a free service to the yoga community in Australia publicising news, events, community service and research, and encouraging return visits to the survey website. Ten issues of the email newsletter were produced between June 2005 and March 2006, as shown in the project timeline in Section 3.17.

Tell a friend A ‘tell-a-friend’ form (Appendix 30) was created on the website to facilitate word-of- mouth recruitment, enabling website visitors to send an ‘e-card’ (of the postcard) to a friend or to a group of friends at once. The form was used 417 times during the survey period.

3. Methodology

3.12. Potential for recruitment bias

It was expected that these recruitment methods would prove cost-effective in attracting large numbers of participants. However, it is acknowledged that contacting people who practice yoga through yoga studios, yoga teachers and groups of yoga teachers, could create a source of recruitment bias. For example, teacher associations, groups, schools or teachers who actively supported the survey and encouraged their students to participate could be over-represented in the results. However, given that every yoga school and teacher listed in the national Yellow Pages and Business White Pages in 2004, or able to be found by Google searches, was contacted by mail or email and where possible by both methods, it was felt that potential recruitment bias was minimised by all listed teachers having equal opportunity to participate themselves and to encourage their students to participate.

Other potential sources of bias are discussed later in ‘Strengths and weakness of this study’.

3.13. Registration for the survey

The registration process required people to select a username and password and enter their email address. They were then sent an automatically generated email and asked to check their email account and click the link in the email to prove ownership of the email address.

Email reminders were later sent to people who:

started but did not complete the registration process completed registration but did not commence the survey commenced the survey but did not complete it

This approach resulted in 4218 registrations of whom 3892 completed some or all of the survey, and of whom 3832 were from Australia.

Of the 4218 registrations, 326 were incomplete. Many of these people were initially unsuccessful in validating their email address and registered again successfully with a different username. Unvalidated registrations were not able to be used to complete the survey.

3.14. Modular survey design

Participants were required to complete the first module (group of questions) of the survey; the demographic/socio-economic module, after which they were able to select which of the other modules they wanted to complete. The first module contained a number of compulsory questions, such as age, gender and postcode. Other than these demographic questions, most questions were voluntary. Some answers given in the first module also determined which of the other modules would be made available to the participant. For example, if identified as a yoga teacher, a participant would be offered an additional module of questions related to their teaching.

3. Methodology

Table 3.14.1 shows the numbers of participants who completed each module:

Table 3.14.1. Numbers of participants who completed each module

Survey Module Participants (N=)

1 Demographic, socio economic and general information (required) 3832 2 Practice (optional) 3720 3 Health (optional) 3616 4 Teaching (optional for teachers only) 1015 5 Pranayama (optional for experienced pranayama practitioners only) 1709 6 Injuries (optional) 3414 7 Flow (subjective experience) (optional) 3288

Module 4 collected data specifically for the yoga teaching profession and is reported separately. Modules 5 and 7 collected data for research projects being conducted by Philip Stevens (Swami Samnyasanand) and Dr Sue Jackson respectively. The Flow responses (Module 7) are summarised in this report.

Given that the survey was quite long (expected to take about 30 minutes for participants to complete), the ability for participants to logout and return later, and the ability for the researchers to follow-up incomplete surveys by email, was considered important. Also deemed important was to allow voluntary completion of the survey questions and modules by participants. This approach proved successful, with 3299 participants voluntarily completing each of the five main modules of the survey.

In total, 20,594 survey modules (pages of questions) were submitted by participants.

3. Methodology

3.15. Website statistics

The website intended to host the survey was launched in October 2004, eight months ahead of the survey period, in order to accept registrations of interest from potential participants. The website attracted more than 20,000 unique visitors (based on unique IP addresses each month) over the 14 months to January 2006 (comprising the 8 month lead-in and the 6 month survey period).

Table 3.15.1 below shows the actual visitors to the website during the 6 ½ month survey period (17 June 2005 - 6 January 2006) taken from the website logs (Appendices 35-37):

Table 3.15.1. Website statistics during the actual survey period

Unique Month visitors No. of visits Pages served Jun-05 656 1098 5762 Jul-05 1432 2237 17452 Aug-05 1977 3112 21921 Sep-05 2379 3642 27564 Oct-05 2224 3380 26550 Nov-05 2338 3544 22462 Dec-05 1664 2485 18758 Jan-06 885 1394 7022 TOTALS 13555 20892 147491

Note: Website statistics are not available from Oct 04-July 05 due to a later server error.

The number of return visits to the website by survey participants was not recorded. However, manual inspection of the dates and times the survey modules were submitted by participants suggests that many participants took advantage of the option to logout and return later.

3. Methodology

3.16. Data Collection and Analysis:

Collection and storage Data entered into the survey forms by participants was collected on a password- secured web server and automatically backed up daily to another storage device on the web server. Data was also backed up weekly by the researcher to another password-protected computer.

Data checking On completion of the survey period on 6 January 2006, data was downloaded from the webserver in Microsoft Excel format. It was imported into Microsoft Access for extensive checking. Data was checked for any signs of manipulation, such as multiple entries from a single login name, and multiple entries from a single IP address. No attempt to manipulate the data was found.

Exclusions Participants were able to self-report their country of residence. Accuracy of self- reporting was also checked against an IP address to country database369. The self- reporting of country of residence was found to be accurate and 60 surveys completed by overseas residents were excluded from the data analysis. All other respondents were included.

Data Analysis Quantitative data was concurrently analysed in SPSS Version 15370, Microsoft Access, and Microsoft Excel, depending on the nature of the query and output format required. Qualitative data was manually assessed, coded and grouped by words and phrases or similar responses. Word counts and phrase counts were performed using suitable software371.

• Tests for significance Given the opportunistic nature of the sample and the lack of a denominator for comparison (eg; people who do not practice yoga), it was expected that reporting would be limited to frequencies, means and standard deviations. However tests for significance between variables may be appropriate in some instances if not potentially misleading in the presence of other confounding factors and sources of bias.

369 IP2Location.com http://www.ip2location.com/free.asp. Accessed 15/1/06. 370 Amos Development Corporation. Stat Pack for Social Sciences (SPSS) Version 15. http://www.spss.com. Accessed 15/2/06. 371 Cro-code Software. Textanz Text analyser. http://www.cro-code.com/.Accessed 15/2/06.

3. Methodology

3.17. Yoga in Australia project timeline

A detailed timeline of the whole project is provided in Table 3.17.1 below.

Table 3.17.1. Yoga in Australia project timeline

Month Event Description Feb 04 Yoga in Australia project commenced Apr 04 Research proposal submitted to RMIT Jul 04 Literature review commenced Aug 04 Speaker International Conference on Yoga and its Applications, Vedanta Centre of Sydney. Announced yoga survey, distributed handouts, and collected registrations of interest. Presented conference paper: Yoga in Australia – a landmark web-based national survey Sep 04 Speaker International Conference on Yoga and its Applications, Vivekananda Education Research and Therapy Institute, Melbourne. Announced yoga survey, distributed handouts, and collected registrations of interest. Presented conference paper: Yoga in the West: Beyond Exercise, Beyond Therapy Nov 04 Advertising Australian Yoga Life magazine Oct 04 Yoga in Australia website launched, allowing visitors to register interest online Oct 04 Created database of yoga schools and teachers from the White Pages and Yellow Pages online (~ 900 entries), and from an extensive Google search. Total ~1500 database entries (~300 with email addresses) Oct 04 E-newsletter To email datatabase of yoga schools and teachers ~ 300 Oct 04 E-newsletter To EMP (yoga mat wholesaler) clients ~ 1500 Oct 04 First draft of survey questions created Nov 04 Speaker Adv. Diploma of Yoga Teaching, Council of Adult Education, Melbourne. Presented draft survey questions for comment Nov 04 Speaker Australian School of Classical Yoga, Melbourne. Presented draft survey questions for comment Nov 04 Speaker Gita Yoga Teachers Guild, Gita International, Melbourne. Presented draft survey questions for comment Nov 04 Speaker Shiva Meditation Centre, Melbourne. Presented draft survey questions for comment Feb 05 Final draft of survey questions created Feb 05 Ethics application submitted to RMIT Mar 05 50,000 postcards printed Mar 05 Advertising Australian Yoga Life magazine Apr 05 Attended YIDL workshop with Swami Maheshwarananda in Melbourne. Distributed ~150 postcards and handouts Apr 05 Media Living Now magazine – ‘Tuning into the Planet’ May 05 Media Australian Yoga Life magazine – ‘National Yoga Survey’ May 05 Speaker GITA Yoga Teachers Guild, GITA International, Melbourne May 05 Speaker 1st Annual Research Conference, School of Health Sciences, RMIT University, Melbourne. Abstract presentation May 05 Ethics approval received Jun 05 Survey website launched - data collection commenced 17 June

3. Methodology

Table 3.17.1. Yoga in Australia project timeline (continued)

Month Event Description Jun 05 Press release RMIT Media Release. ‘RMIT conducts first nationwide yoga survey’ Jun 05 Media Radio interviews following media release Jun 05 E-newsletter Bulk email to email database ~ 1800 Jun 05 E-newsletter Bulk email to YTAA members ~ 800 Jun 05 E-newsletter Bulk email to EMP (yoga mat wholesaler) clients ~ 1500 Jun 05 Media Sunday Telegraph, NSW. ‘Study into yoga’s benefits’ Jun 05 Media Sun Herald, NSW. ‘Yoga teachers at a stretch as scramble for students hots up’ Jul 05 Advertising Australian Yoga Life magazine Jul 05 E-newsletter Bulk email to email database ~ 2600 Jul 05 Direct mail To database of yoga teachers and schools ~ 1800 Jul 05 Speaker Yoga Research Conference. Swan Research Institute & Yoga Association of Victoria, Rocklyn, Victoria Jul 05 Media Heidelberg Weekly. ‘Why yoga’s in vogue’ Jul 05 Media Melbourne Times. ‘Why yoga’s in vogue’ Jul 05 Media Australian Yoga Life magazine -. ‘Pranayama Research at RMIT - where science and yoga meet’ Jul 05 Speaker Adv. Diploma of Yoga Teaching, Council of Adult Education, Melbourne Jul 05 Speaker International Conference on Yoga – Science of Infinite Possibilities, Vedanta Centre of Sydney, Sydney. Presented abstract and poster Jul 05 Speaker 11th International Holistic Health Conference, AIMA, Sunshine Coast, QLD. August 05. Presented abstract and poster Aug 05 E-newsletter Bulk email to email database ~ 3000 Aug 05 Ethics approval to provide incentives to participants if required Aug 05 E-newsletter Bulk email to email database ~ 3500 Sep 05 Media Sydney Morning Herald. ‘Breathe, stretch, and now for the rugby prop pose’ Sep 05 E-newsletter Bulk email to email database ~ 3700 Sep 05 Speaker “Disability and Spirituality” Seminar, Bear in Mind and Headway Victoria, Melbourne Town Hall Sep 05 Speaker ‘Day of Union’. Australian Fellowship of Yoga Teachers, Melbourne Sep 05 E-newsletter Bulk email to email database ~ 4000 Sep 05 Direct mail To database of yoga teachers and schools, remaining ~ 1200 Sep 05 Direct mail To Iyengar Association members ~ 270 Oct 05 Media The Age Weekender magazine, Melbourne. ‘Healing or Hurting’ Oct 05 Media Living Now magazine - Yoga Practice in Australia Oct 05 Direct mail To YTISA association members ~ 70 Oct 05 Direct mail To SYTA members ~ 220 Oct 05 E-newsletter Bulk email to email database ~ 4700 Oct 05 Exhibitor Health & Well-being Expo, Melbourne. Distributed ~1000 postcards Nov 05 Advertising Australian Yoga Life magazine Nov 05 Direct mail To database of yoga teachers and schools, remaining ~400 Nov 05 Speaker Adv. Diploma of Yoga Teaching, Council of Adult Education, Melbourne. Distribution of handouts and postcards ~ 30

3. Methodology

Table 3.17.1. Yoga in Australia project timeline (continued)

Month Event Description Nov 05 Media ABC Health Matters feature. ‘Om, What a Feeling’. Nov 05 E-newsletter Bulk email to email database ~ 5300 Dec 05 Press release RMIT Media Release. ‘National yoga survey, last chance to participate’ Dec 05 Media Radio interviews following press release Dec 05 Ethics approval to collect data from overseas if required Dec 05 E-newsletter Bulk email to email database ~ 5500. Final email reminders sent Jan 06 Survey closed 6 January Jan 06 E-newsletter Bulk email to email database ~ 5800 Jan 06 Media Medical Observer. ‘More than just posturing’ Mar 06 Advertising Australian Yoga Life magazine Mar 06 E-newsletter Bulk email to email database ~ 6000 Apr 06 Speaker 1st International Ayurveda and Yoga Conference, Sydney. ‘Preliminary results of the national yoga survey’ Apr 06 Media Herald Sun, Melbourne, Health Watch feature. ‘Body in Karma State’. Preliminary results of the national yoga survey Apr 06 Media Podcast on wellspringflow.net Apr 06 Speaker Easter Research Conference. Satyananda Yoga Ashram, Mangrove Mountain, NSW Apr 06 Speaker Public meeting of the Yoga Teachers Association of Australia, Sydney May 06 Speaker Public meeting of the Yoga Teachers Association of Australia, Brisbane May 06 Speaker Public meeting of the Yoga Teachers Association of Australia, Melbourne May 06 Speaker GITA Yoga Teachers Guild, GITA International, Melbourne Jun 06 Speaker Adv. Diploma of Yoga Teaching, Council of Adult Education, Melbourne Jun 06 Press release RMIT Media Release. ‘Yoga – good for the body, better for the mind’ Jun 06 Media Radio interviews following press release Jun 06 Media Free Press, Regional Victoria. ‘Good for the body, better for the mind’ Jun 06 Media Channel 9 Today Show. ‘Preliminary results of the national yoga survey’ Jun 06 Media Sydney Morning Herald. ‘Virtually Unqualified’ Jun 06 Media The Age, Melbourne. ‘Yoga brings peace of mind’ Jun 06 Media Gippsland Times. ‘World-first yoga study’ Jul 06 Speaker Public meeting of the Yoga Teachers Association of Australia, Perth Jul 06 Speaker 2nd Annual Research Conference, School of Health Sciences, RMIT University, Melbourne. July 06. Presented abstract and poster Aug 06 Media Frankston Leader. ‘A popular alternative’. August 06 Aug 06 Speaker 12th International Holistic Health Conference, AIMA, Queenstown, New Zealand. Presentation in the Scientific Abstract Stream Oct 06 Speaker Satyananda Yoga Teachers Association Professional Development Day, Sydney Dec 06 Journal article Penman S, Cohen M, Stevens P, Jackson S. Australians self-prescribe yoga for mental health: a sign of the times. J Aust Int Med Assoc (JAIMA). 2006 Dec; 11(3):10-11. 2007 Data analysis and writing of thesis and report Mar 08 Submission of thesis and publication of final report

4. Results

4.1 Demographic and socio-economic characteristics of respondents

As described earlier in the Methodology section, subject to the recruitment methodology, participants were self-selecting to visit the Yoga in Australia website and to complete a web- based questionnaire.

Over the six month survey period:

5972 people joined the on-line community by subscribing to receive the monthly email newsletter, of whom

4218 people registered for the survey by validating their email address, of whom: o 3892 completed some or all of the survey, of whom o 3832 were from Australia

Participants were required to complete the first module of the survey (the demographic/socio-economic questions) first, after which they were able to select which of the other modules they wanted to complete. The demographic module contained a number of compulsory questions, which included whether the participant was a teacher or a student, their age, gender, height, weight, handedness, country of residence, and postcode. Some answers given in the demographic module also determined which of the other modules would be made available to the participant.

4.1.1. Yoga teaching characteristics of respondents

1265 respondents identified themselves as any one or more of the following:

a yoga or meditation teacher (n=1040) training to become a yoga or meditation teacher (n=324) someone who trains yoga or meditation teachers (n=220) a yoga therapist (specialist yoga teacher) (n=263)

Respondents were able to select multiple responses to this question, for example, they were able to identify themselves as both a yoga teacher and also engaged in ongoing teacher training, as shown at the bottom of the screenshot in Figure 4.1.1 below, and in the frequency of responses in Table 4.1.2.

4. Results

Figure 4.1.1. Screenshot of the first page of the demographic module of the questionnaire

Table 4.1.2. Summary of the self-reported yoga teaching characteristics of 1265 respondents

n= Teacher only 582 Trainee only 219 Trainer only 0 Therapist only 5 Teacher and trainee 77 Teacher and trainer 109 Teacher and therapist 154 Trainee and trainer 0 Trainee and therapist 1 Trainer and therapist 0 Teacher and trainee and trainer 15 Teacher and trainee and therapist 7 Teacher and trainer and therapist 91 Trainee and trainer and therapist 0 Teacher and trainee and trainer and therapist 5

Of the 1265 respondents who identified themselves in any one or more of these groupings, it was decided they had a vocational interest in yoga teaching and therefore should be considered separately from the remaining 2567 respondents. Accordingly, results are reported separately for ‘teachers’ and ‘students’ throughout this report.

4. Results

4.1.2. Understanding the styles and style groups used in this report

Participants were asked to describe the school or style of yoga or meditation they best identified with. This was further explained as, “for most people, this will be the school or style of yoga you currently practice or have practised the most.” A total of 3678 (of 3832) respondents answered this question.

The terms ‘Hatha’, ‘contemporary’ and ‘contemporary classical’ were commonly used by participants to describe their style of yoga. These are generic terms which could apply to many styles of yoga. For example, Satyananda yoga might be described by participants as either Hatha yoga or contemporary classical yoga.

Where a participant listed multiple schools attended, multiple styles practised, or indicated that their style was a blend of styles, the school or style listed first was taken to be the predominant style, with some exceptions. For example, if a participant listed their style of yoga as ‘Hatha, Gita’ (Gita yoga can be described as a style of Hatha yoga), Gita was taken as the predominant style.

In some cases, participants gave the name of their school. Where schools were known to teach only one style of yoga, the name of the school was used instead, to enable it to be easily identified in the results.

Given the wide range of responses to this question, a new ‘style group’ variable was created in order to compare groups of styles with other variables in the data. That is, the schools and styles of yoga reported by participants were manually coded by the researcher into groupings of similar styles, for example, Turiya yoga is known to be a meditative style of yoga therefore was included in the Meditation group along with other meditative styles of yoga.

Table 4.1.3 Yoga styles included within each main grouping.

Table 4.1.3. Styles by style group

1. Meditation Styles of yoga focusing on meditation, including Siddha, Sahaja, Raja (e.g. Brahma Kumaris), Turiya, Bhakti, Dharma, Samata, TM, Tantra, and people who only practised pranayama 2. General People who called their style ‘classical’, ‘contemporary’, ‘contemporary classical’, ‘eclectic’, Gita, Yoga in Daily Life, Dru, Ryoho, Oki Do, Kundalini, Integral, IYTA, Ayur, and others 3. Satyananda People who described their style as Satyananda 4. Hatha People who only described their style as ‘Hatha’ 5. Iyengar People who described their style as Iyengar 6. Dynamic Stronger, more dynamic styles of yoga, including Ashtanga, Vinyasa Flow, Bikram, Synergy, Power, and others 7. Others Styles not able to be categorised due to a lack of information 8. Hybrid Including Yoga Chi Gung, Pilates, Yogalates and Body Balance Note: Contemporary Classical: Respondents who described their style of yoga as ‘contemporary’, ‘classical’, ‘contemporary classical’ or ‘eclectic’. Vinyasa, Flow: Respondents who described their style of yoga as ‘vinyasa’ or ‘flow’ or ‘vinyasa flow’.

4. Results

Table 4.1.4 shows the numbers of participants by style group.

Table 4.1.4. Participants by style group

Participant Group Student Teacher Total Style 1. Meditation Count 33 62 95 Group % within Participant Group 1.4% 5.0% 2.6% 2. General Count 417 440 857 % within Participant Group 17.2% 35.1% 23.3% 3. Satyananda Count 227 180 407 % within Participant Group 9.4% 14.4% 11.1% 4. Hatha Count 377 95 472 % within Participant Group 15.5% 7.6% 12.8% 5. Iyengar Count 730 264 994 % within Participant Group 30.1% 21.1% 27.0% 6. Dynamic Count 469 162 631 % within Participant Group 19.3% 12.9% 17.2% 7. Others Count 152 30 182 % within Participant Group 6.3% 2.4% 4.9% 8. Hybrid Count 21 19 40 % within Participant Group .9% 1.5% 1.1% Total Count 2426 1252 3678 % within Participant Group 100.0% 100.0% 100.0%

Where styles had sufficient respondents, they were selected for comparison throughout these results. These included Ashtanga (262 respondents), Bikram (159), Contemporary Classical (213), Gita (140), Hatha (472), Iyengar (994), Satyananda (407), Synergy (121) and Yoga in Daily Life (101). These nine styles are collectively referred to as the ‘selected styles’.

Table 4.1.5 shows the numbers of participants by all styles with the allocated style grouping number in brackets ().

4. Results

Table 4.1.5. Participants by schools and styles of yoga and meditation Cou Participant Group Student Teacher Total Schools No answer 141 13 154 and styles Acharya's Yoga (2) 6 8 14 (Grouping Ananda Marga (1) 1 4 5 shown in Anusara (2) brackets) 2 6 8 Art of Living (2) 3 6 9 Ashtanga (6) 190 72 262 Aust College of Classical Yoga (2) 1 15 16 Ayur (2) 21 8 29 Bay School (8 fold path) (2) 27 3 30 Bhakti (1) 2 1 3 Bhava (2) 2 3 5 Bikram (6) 138 21 159 Brahma Kumaris (1) 2 14 16 Contemporary Classical (2) 108 105 213 Dharma (1) 6 3 9 Dru (2) 9 21 30 Gita (2) 77 63 140 Hatha (4) 377 95 472 Hybrid (8) eg: Yoga Chi Gung, Yogalates 21 19 40 Integral (2) 6 27 33 Iyengar (5) 730 264 994 IYTA (2) 4 21 25 Jivamukti (6) 1 6 7 Krishnamacharya (2) 17 31 48 Kundalini (2) 12 16 28 Others (7) 152 30 182 Power (6) 12 7 19 Pranayama (1) 7 3 10 Radiant Light (2) 2 2 4 Raja (1) 2 3 5 Ryoho, Ki, Oki Do (2) 22 21 43 Sahaja (1) 2 10 12 Sakshin Ghatastha (6) 1 3 4 Samata (1) 1 3 4 Satyananda (3) 227 180 407 Shadow (6) 3 6 9 Shanti (2) 8 4 12 Siddha (2) 5 15 20 Sivananda (2) 6 25 31 Svaroopa (2) 4 4 8 Svastha (2) 3 1 4 Sw Sarasvati (2) 1 9 10 Synergy (6) 99 22 121 Tantra (1) 2 1 3 TM (1) 3 1 4 Turiya (1) 0 4 4 Vinyasa, Flow (6) 25 25 50 Vivekananda (2) 9 7 16 Yoga in Daily Life (2) 67 34 101 Total 2567 1265 3832

4. Results

4.1.3. State of residence

Respondents were required to enter their postcode, from which State of residence was determined. All participants answered this question.

Table 4.1.6 below shows the residency of yoga survey participants by State and also by participant group (student or teacher). There was a lower than average proportion of teachers to students participating in NT (20% teachers), SA (28.8% teachers) and TAS (23.3% teachers), but also lower participant numbers in those states, which when combined with methodological considerations, may not reflect a state of residence or rurality effect on teacher student ratios.

Table 4.1.6. State of residence by participant group

Participant Group Student Teacher Total State ACT Count 61 31 92 % within State 66.3% 33.7% 100.0% % within Participant Group 2.4% 2.5% 2.4% NSW Count 982 486 1468 % within State 66.9% 33.1% 100.0% % within Participant Group 38.3% 38.4% 38.3% NT Count 68 17 85 % within State 80.0% 20.0% 100.0% % within Participant Group 2.6% 1.3% 2.2% QLD Count 291 172 463 % within State 62.9% 37.1% 100.0% % within Participant Group 11.3% 13.6% 12.1% SA Count 94 38 132 % within State 71.2% 28.8% 100.0% % within Participant Group 3.7% 3.0% 3.4% TAS Count 79 24 103 % within State 76.7% 23.3% 100.0% % within Participant Group 3.1% 1.9% 2.7% VIC Count 870 432 1302 % within State 66.8% 33.2% 100.0% % within Participant Group 33.9% 34.2% 34.0% WA Count 122 65 187 % within State 65.2% 34.8% 100.0% % within Participant Group 4.8% 5.1% 4.9% Total Count 2567 1265 3832 % within State 67.0% 33.0% 100.0% % within Participant Group 100.0% 100.0% 100.0%

The proportion of participants from each State is further compared to the Australian population in Section 4.1.7.

4. Results

4.1.4. Understanding the Mean, Standard Deviation and N values

The following notes are to assist with understanding the tables and figures throughout the Results section.

The mean is the value with 50% of the values on either side of the mean. It is a measure of centre tendency and depending on the nature of the variable, may be similar to an ‘average’.

The standard deviation (SD) is a measure of the spread of the values from the mean. One standard deviation will return 68% of the values (e.g. 34% either side of the mean), while two standard deviations will return 95% of the values and the higher the SD, the wider the range of values on the ‘normal distribution’ curve.

The ‘N’ or ‘n’ number is the number of participants in the sample or in a sub-category of the sample respectively. Where participant numbers are low, results may be unreliable. As a general rule (although an over-simplification), more than 50 participants in a given category will usually produce a relatively normal distribution. However, whether the resulting mean of that distribution is representative of any larger population is subject to recruitment considerations.

Using Figure 4.1.7 below as an example, the ages of teachers are compared to the ages of students. The spread of students’ ages shown in blue (12-85 y.o, N=2567, M=41.43, SD=11.56m) is slightly wider than the spread of teachers ages shown in green (19-85 y.o, N=1265, M=43.63, SD 10.73), therefore the students’ SD is slightly higher.

The students’ curve suggests a normal (bell curve) distribution, slightly skewed to the left compared to the teachers, as expected given that students were found to be 2 years younger than their teachers on average. However the teachers’ curve appears bi-modal; that is a probability distribution with two different modes appearing as distinct peaks in the probability density function.

This could suggest a mixture of two different unimodal distributions (e.g. teachers may tend to fall into two separate age distributions), or may be a reflection of the recruitment techniques or other unknown confounding factors in the methodology.

4. Results

Figure 4.1.7. Age of participants by participant group

Participant Group 5.0% Student (n=2567) Teacher (n=1265)

4.0%

3.0%

2.0% Percent of participant group participant of Percent

1.0%

0.0% 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52 54 56 58 60 62 64 66 68 70 72 74 76 80 83 12 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 55 57 59 61 63 65 67 69 71 73 75 77 81 85 Age Interestingly, a visual inspection of the graph also shows that both teachers and students were less likely to be 39 or 44 years old than all other ages between 32 and 53 years old. Rather than representing a bi-modal distribution curve, this may suggest a tendancy of participants to ‘round off’ their age to the nearest five years as there is no plausible reason why there would be substantially less 39 and 44 year old participants than say, 40 and 45 year olds. This same apparent tendency of participants to ‘round off’ was also evident in the ‘years practising’ question in Section 4.2.5. The implications for this analysis therefore are a potential unreliability of the year-by-year age data, which is why five year groupings of ages have been used (self-reported ages have been grouped into 5-year groups, e.g. 36-40 and 41 to 45 year olds) for comparison purposes in this document, for example for comparison with ABS data in Section 4.1.7. which uses the same five year groupings.

4. Results

4.1.5. Age of participants

This was also a compulsory question, however four responses (received on the same day) were found to be missing in the web server data, suggesting a short-term database connectivity problem, leaving 3828 responses to this question.

The mean age of students (M=41.43, SD=11.56) was lower than the mean age of teachers (M=43.63, SD 10.73). Given that teachers had practised yoga for nearly seven years longer than their students (see the Practice section later), this was to be expected.

Participant ages were grouped as shown in Table 4.1.8 for comparison with ABS Census 2006 data in Section 4.1.7.

Table 4.1.8. Participants by age group and participant group

Participant Group Student Teacher Total Age 15-24 y.o. Count 122 15 137 Group % within Participant Group 4.8% 1.2% 3.6% 25-34 y.o. Count 718 283 1001 % within Participant Group 28.0% 22.4% 26.1% 35-44 y.o. Count 716 378 1094 % within Participant Group 27.9% 29.9% 28.6% 45-54 y.o. Count 626 375 1001 % within Participant Group 24.4% 29.7% 26.1% 55-64 y.o. Count 316 178 494 % within Participant Group 12.3% 14.1% 12.9% 65-74 y.o. Count 59 26 85 % within Participant Group 2.3% 2.1% 2.2% 75-84 y.o. Count 7 7 14 % within Participant Group .3% .6% .4% 85+ y.o. Count 1 1 2 % within Participant Group .0% .1% .1% Total Count 2565 1263 3828 % within Participant Group 100.0% 100.0% 100.0%

4. Results

Table 4.1.9 below shows the mean age of all participants by style group and gender (students and teachers combined).

Table 4.1.9. Mean age of all participants by style group and gender Age Style Group Gender Mean N SD 1. Meditation Male 42.57 30 12.522 Female 44.05 65 11.438 Total 43.58 95 11.744 2. General Male 44.08 117 11.717 Female 43.46 739 11.247 Total 43.54 856 11.307 3. Satyananda Male 49.42 53 11.086 Female 46.80 353 11.646 Total 47.14 406 11.595 4. Hatha Male 46.11 57 11.764 Female 44.16 415 11.450 Total 44.40 472 11.493 5. Iyengar Male 43.46 168 11.149 Female 42.00 824 10.321 Total 42.25 992 10.474 6. Dynamic Male 39.13 122 8.484 Female 34.29 509 7.941 Total 35.23 631 8.266 7. Others Male 39.86 21 11.074 Female 42.65 160 12.671 Total 42.33 181 12.500 8. Hybrid Male 38.00 4 9.933 Female 40.75 36 9.044 Total 40.48 40 9.038 Total Male 43.26 572 11.216 Female 41.98 3101 11.275 Total 42.18 3673 11.274

4. Results

Table 4.1.10 below shows the mean age of students by selected styles and gender

Table 4.1.10. Mean age of students by selected styles and gender Age Style Gender Mean N SD Ashtanga Male 38.07 28 8.437 Female 34.64 162 7.637 Total 35.15 190 7.832 Bikram Male 39.50 28 7.858 Female 31.92 110 7.960 Total 33.46 138 8.482 Contemporary Classical Male 45.83 12 9.054 Female 45.24 96 12.327 Total 45.31 108 11.974 Gita Male 40.67 9 11.358 Female 41.01 68 11.108 Total 40.97 77 11.062 Hatha Male 46.20 45 12.413 Female 44.21 332 11.629 Total 44.45 377 11.726 Iyengar Male 43.36 117 11.082 Female 41.65 611 10.628 Total 41.93 728 10.713 Satyananda Male 48.69 26 11.249 Female 45.72 201 12.327 Total 46.06 227 12.221 Synergy Male 39.39 23 7.656 Female 35.37 76 8.485 Total 36.30 99 8.436 Yoga in Daily Life Male 41.20 5 13.535 Female 40.53 62 10.815 Total 40.58 67 10.920

Practitioners of Satyananda yoga were found to be the oldest with a mean of 46 years, followed by Contemporary Classical at 45.3 years. Female Bikram yoga students were the youngest on average at 31.9 years old.

Tables 4.1.10 above (students) and 4.1.11 below (teachers) allows a comparison between the average age of students and teachers in the selected styles.

Note: The mean should not be taken as reliable where the numbers of respondents was low.

4. Results

Table 4.1.11 below shows the mean age of teachers by selected styles and gender

Table 4.1.11. Mean age of teachers by selected styles and gender Age Style Gender Mean N SD Ashtanga Male 40.38 13 8.646 Female 36.02 59 6.778 Total 36.81 72 7.282 Bikram Male 44.88 8 13.378 Female 32.77 13 8.156 Total 37.38 21 11.783 Contemporary Classical Male 44.78 18 11.379 Female 44.21 87 11.225 Total 44.30 105 11.198 Gita Male 52.67 3 2.517 Female 45.69 59 10.505 Total 46.03 62 10.364 Hatha Male 45.75 12 9.382 Female 43.98 83 10.768 Total 44.20 95 10.574 Iyengar Male 43.71 51 11.408 Female 43.00 213 9.335 Total 43.14 264 9.750 Satyananda Male 50.11 27 11.095 Female 48.22 152 10.552 Total 48.51 179 10.625 Synergy Male 35.67 6 7.394 Female 36.06 16 5.567 Total 35.95 22 5.932 Yoga in Daily Life Male 41.00 10 13.703 Female 41.83 24 10.741 Total 41.59 34 11.479

4. Results

4.1.6. Rurality

Participants were required to select whether they lived in an urban or rural location, using a scale designed to allow comparison with the Rural, Remote and Metropolitan Areas (RRMA) scheme mentioned earlier in the Methodology section. As shown in Table 4.1.12 below, teachers were less likely to live in a capital city than students, and more likely to live in a small rural centre or a remote area.

Table 4.1.12. Rurality by participant group

Participant Group Student Teacher Total Rurality Capital city Count 1464 642 2106 % within Participant Group 57.0% 50.8% 55.0% Metropolitan centre Count 654 316 970 (pop >100,000) % within Participant Group 25.5% 25.0% 25.3%

Large rural centre (pop Count 211 105 316 25,000 - 100,000) % within Participant Group 8.2% 8.3% 8.2% Small rural centre (pop Count 213 160 373 < 25,000) % within Participant Group 8.3% 12.6% 9.7% Remote area Count 25 42 67 % within Participant Group 1.0% 3.3% 1.7% Total Count 2567 1265 3832 % within Participant Group 100.0% 100.0% 100.0%

4. Results

4.1.7. Comparison of the demographic characteristics of respondents with the Australian population

Demographic characteristics of respondents were compared to population data from the Australian Bureau of Statistics (ABS), referred to earlier in the Methodology section, to suggest the extent to which survey respondents might be considered representative of the Australian polulation.

By State Respondents from NSW and VIC were over-represented, while respondents from QLD, SA and WA were under-represented compared to the population. This may be a reflection of the recruitment methodology for the survey. Data is not available on yoga participation by State from either the ABS or the ERASS publications. Therefore, while it is possible to say that survey participants did not reflect the Australian population by State of residence, it is not possible to say whether they reflected the State of residence of Australians who practice yoga.

By age group As expected, survey participation by age group was different from the Australian population. Survey participants were over-represented in the 25-54 year old age groups (the age groups most likely to practice yoga), and under-represented in the other age groups.

By metropolitan or rural location The survey asked participants to report whether they lived in an urban or rural location, using a scale designed to allow directly comparison with the seven-point scale of the Rural, Remote and Metropolitan Areas (RRMA) classification. However, a direct comparison of rurality of survey participants to the general population was made difficult by a lack of recent figures utilising the RRMA classification scheme (the most recent being 1996 from the ABS). Since 2001, the ABS utilised a different, simplified five-point scale of remoteness, which limits direct comparison to the RRMA scheme.

For example, it is unclear as to the lower and upper bounds of the population of a ‘major city’ or ‘inner regional’ area using the ABS five point scale. Therefore, it was not possible to determine whether yoga survey participants represented the rurality of the Australian population.

A summary of the comparison between the demographic characteristics of survey respondents and the Australian population is shown in Table 4.1.13.

4. Results

Table 4.1.13. Comparison of demographic characteristics of yoga survey respondents with the Australian population (from ABS Census data)

Yoga Survey By State ABS 2006 Census Participation NSW 33.17% 38.30% VIC 24.71% 34.00% QLD 19.64% 12.10% SA 7.55% 3.40% WA 9.94% 4.90% TAS 2.38% 2.70% NT 1.01% 2.20% ACT 1.60% 2.40% Total 100.00% 100.00%

By age group ABS 2006 Census Yoga Survey under 15 19.83% n/a 15-24 13.62% 3.60% 25-34 13.48% 26.10% 35-44 14.80% 28.60% 45-54 13.91% 26.10% 55-64 11.04% 12.90% 65-74 6.92% 2.20% 75-84 4.78% 0.40% 85+ 1.62% 0.10% Total 100.00% 100.00%

By metropolitan or rural location (RRMA classification) ABS 2005 Trends Yoga Survey 1. Capital cities (major cities ) 66.20% 55.00% 2. Large metro > 100,000 n/a 25.30% 3. Large rural 25,000 - 99,999 (inner regional ) 21.20% 8.25% 4 and 5. Small rural and other rural < 25,000 (outer regional ) 10.20% 9.70% 6 and 7. Remote and other remote < 5000 (remote/very remote ) 2.40% 1.85% Total 100.00% 100.00%

In summary, the yoga survey participants, while somewhat reflective of the distribution of the Australian population by State and rurality, cannot be said to be representative of the Australian population. They also cannot be said to be representative of all Australians who practice yoga, given that the information needed to be able to make this comparison (e.g. yoga participation by State from the ABA or ERASS) is not available.

4. Results

4.1.8. Gender

Participants were asked to indicate their gender. Six responses were missing (presumably due to the same web-server error as affected the ‘age’ question), leaving 3830 responses to this question.

As shown in Table 4.1.14 below, 85.5% of students were female, and 82.6% of teachers were female, therefore teachers were slightly more likely to be male than their students.

Table 4.1.14. Gender by participant group

Gender Male Female Total Participant Student Count 371 2195 2566 Group % within 14.5% 85.5% 100.0% Participant Group Teacher Count 220 1044 1264 % within 17.4% 82.6% 100.0% Participant Group Total Count 591 3239 3830 % within 15.4% 84.6% 100.0% Participant Group

As shown in Table 4.1.15 and Table 4.1.16, gender varied by style group and even more between selected styles.

Comparing styles practised across men and women, Yoga in Daily Life had the highest proportion of women with 92.5%, followed by Satyananda (88.5%), and Gita (88.3%); whereas the more physical styles of yoga had the highest proportion of men, like Yoga Synergy (23.2% men), Bikram (20.3%), Iyengar (16.0%), and Ashtanga (14.7%). There may have been other styles with a high proportion of men, but not with sufficient numbers in the yoga survey to make any comment.

Overall, male participation in the stronger, more dynamic styles of yoga was about 18%, compared to about 11% in the more gentle contemporary classical styles. This male participation was still well short of the overall male participation rate of 23% in the United States found by the Yoga Journal studies discussed earlier.

4. Results

Table 4.1.15. Gender by participant group and style group

Gender Participant Group Male Female Total Student Style 1. Meditation Count 11 22 33 Group % within Style Group 33.3% 66.7% 100.0% 2. General Count 51 366 417 % within Style Group 12.2% 87.8% 100.0% 3. Satyananda Count 26 201 227 % within Style Group 11.5% 88.5% 100.0% 4. Hatha Count 45 332 377 % within Style Group 11.9% 88.1% 100.0% 5. Iyengar Count 117 612 729 % within Style Group 16.0% 84.0% 100.0% 6. Dynamic Count 86 383 469 % within Style Group 18.3% 81.7% 100.0% 7. Others Count 16 136 152 % within Style Group 10.5% 89.5% 100.0% 8. Hybrid Count 1 20 21 % within Style Group 4.8% 95.2% 100.0% Total Count 353 2072 2425 % within Style Group 14.6% 85.4% 100.0% Teacher Style 1. Meditation Count 19 43 62 Group % within Style Group 30.6% 69.4% 100.0% 2. General Count 66 374 440 % within Style Group 15.0% 85.0% 100.0% 3. Satyananda Count 27 152 179 % within Style Group 15.1% 84.9% 100.0% 4. Hatha Count 12 83 95 % within Style Group 12.6% 87.4% 100.0% 5. Iyengar Count 51 213 264 % within Style Group 19.3% 80.7% 100.0% 6. Dynamic Count 36 126 162 % within Style Group 22.2% 77.8% 100.0% 7. Others Count 6 24 30 % within Style Group 20.0% 80.0% 100.0% 8. Hybrid Count 3 16 19 % within Style Group 15.8% 84.2% 100.0% Total Count 220 1031 1251 % within Style Group 17.6% 82.4% 100.0%

4. Results

Table 4.1.16. Gender by participant group and selected styles

Participant Gender Group Male Female Total Student Style Ashtanga Count 28 162 190 % within Style 14.7% 85.3% 100.0% Bikram Count 28 110 138 % within Style 20.3% 79.7% 100.0% Contemporary Classical Count 12 96 108 % within Style 11.1% 88.9% 100.0% Gita Count 9 68 77 % within Style 11.7% 88.3% 100.0% Hatha Count 45 332 377 % within Style 11.9% 88.1% 100.0% Iyengar Count 117 612 729 % within Style 16.0% 84.0% 100.0% Satyananda Count 26 201 227 % within Style 11.5% 88.5% 100.0% Synergy Count 23 76 99 % within Style 23.2% 76.8% 100.0% Yoga in Daily Life Count 5 62 67 % within Style 7.5% 92.5% 100.0% Teacher Style Ashtanga Count 13 59 72 % within Style 18.1% 81.9% 100.0% Bikram Count 8 13 21 % within Style 38.1% 61.9% 100.0% Contemporary Classical Count 18 87 105 % within Style 17.1% 82.9% 100.0% Gita Count 3 60 63 % within Style 4.8% 95.2% 100.0% Hatha Count 12 83 95 % within Style 12.6% 87.4% 100.0% Iyengar Count 51 213 264 % within Style 19.3% 80.7% 100.0% Satyananda Count 27 152 179 % within Style 15.1% 84.9% 100.0% Synergy Count 6 16 22 % within Style 27.3% 72.7% 100.0% Yoga in Daily Life Count 10 24 34 % within Style 29.4% 70.6% 100.0%

4. Results

4.1.9. Country of residence and nationality

Participants were required to select their country of residence, and if different, their country of nationality. This question was primarily to ensure that only Australian respondents were included in the data analysis. As mentioned earlier in the Methodology section, self-reporting of country of residence was also cross-checked against an IP address to country database, resulting in 60 overseas participants being excluded from the data analysis.

Of the 3832 participants from Australia, 82.8% students and 81.1% teachers reported Australian nationality. Selected nationalities are shown in Table 4.1.17 below. There was little difference between the nationalities of teachers and students.

Table 4.1.17. Selected nationalities by participant group

Selected Participant Group Total nationalities Student Teacher Student Australia Count 2125 1026 3151 % within Participant Group 82.8% 81.1% 82.2% Germany Count 25 15 40 % within Participant Group 1.0% 1.2% 1.0% India Count 8 18 26 % within Participant Group .3% 1.4% .7% New Zealand Count 47 33 80 % within Participant Group 1.8% 2.6% 2.1% UK Count 147 61 208 % within Participant Group 5.7% 4.8% 10.5% USA Count 28 22 50 % within Participant Group 1.1% 1.7% 1.3% All others Count 187 90 277 % within Participant Group 7.3% 7.1% 7.2% Total Count 2567 1265 3832 % within Participant Group 100.0% 100.0% 100.0%

4. Results

4.1.10. Handedness

Participants were required to select whether they were right-handed or left-handed. An ambidextrous option was not provided. One response was missing, leaving 3831 participants who answered this question.

Male survey participants were more likely to be left handed (13.7%) than female participants (10.0%), and than the general population (about 10%). Left-handedness in females was about the same as the general population, as shown in Table 4.1.18

Table 4.1.18. Handedness by gender

Handedness Left handed Right handed Total Gender Male Count 81 510 591 % within Gender 13.7% 86.3% 100.0% Female Count 325 2913 3238 % within Gender 10.0% 90.0% 100.0% Total Count 406 3423 3829 % within Gender 10.6% 89.4% 100.0%

This distinction was more pronounced in certain styles of yoga and not at all in others. Table 4.1.19 shows how handedness varied by style group; and Table 4.1.20 shows in more detail how handedness varied between the selected styles.

Table 4.1.19. Summary of handedness by style group and gender

Styles of yoga Left-handed Left-handed men women Meditative (e.g. Sahaja, Siddha, Brahma Kumaris, 13.3% 9.2% Bhakti, Dharma) Satyananda 9.4% 10.5% Iyengar 11.3% 9.6% General (including contemporary classical, Gita, 12.0% 10.3% Yoga in Daily Life) Hatha 15.8% 9.6% (people who just described their style as ‘Hatha’) Strong/Dynamic (e.g. Ashtanga, Vinyasa Flow, 17.2% 10.6% Bikram, Synergy, Power) Others (people who did not provide information 18.2% 10.7% about their style) Total 13.7% 10.0%

Left-handedness in men seemed to be more prevalent in the stronger, more dynamic styles of yoga, with the most extreme examples being Yoga Synergy (24.1%) and Vinyasa Flow (25.0%); however, participant numbers were low in these categories and results must interpreted with caution. Other styles and style groups with higher than expected levels of left-handedness in men were were ‘Hatha’ (15.8%) and Ashtanga (14.6%).

Left-handedness of women remained consistent across all styles, with the exception of Ashtanga (13.1%). Interestingly, where the left-handedness of men was highest (Yoga Synergy and Vinyasa Flow), the left-handedness of women was also the lowest (7.6% and 7.1% respectively).

4. Results

Table 4.1.20. Handedness by selected styles and gender

Handedness Style Left handed Right handed Total Ashtanga Gender Male Count 6 35 41 % within Gender 14.6% 85.4% 100.0% Female Count 29 192 221 % within Gender 13.1% 86.9% 100.0% Total Count 35 227 262 % within Gender 13.4% 86.6% 100.0% Bikram Gender Male Count 5 31 36 % within Gender 13.9% 86.1% 100.0% Female Count 13 110 123 % within Gender 10.6% 89.4% 100.0% Total Count 18 141 159 % within Gender 11.3% 88.7% 100.0% Contemporary Gender Male Count 3 27 30 Classical % within Gender 10.0% 90.0% 100.0% Female Count 17 166 183 % within Gender 9.3% 90.7% 100.0% Total Count 20 193 213 % within Gender 9.4% 90.6% 100.0% Gita Gender Male Count 1 11 12 % within Gender 8.3% 91.7% 100.0% Female Count 13 115 128 % within Gender 10.2% 89.8% 100.0% Total Count 14 126 140 % within Gender 10.0% 90.0% 100.0% Hatha Gender Male Count 9 48 57 % within Gender 15.8% 84.2% 100.0% Female Count 40 375 415 % within Gender 9.6% 90.4% 100.0% Total Count 49 423 472 % within Gender 10.4% 89.6% 100.0% Iyengar Gender Male Count 19 149 168 % within Gender 11.3% 88.7% 100.0% Female Count 79 746 825 % within Gender 9.6% 90.4% 100.0% Total Count 98 895 993 % within Gender 9.9% 90.1% 100.0% Satyananda Gender Male Count 5 48 53 % within Gender 9.4% 90.6% 100.0% Female Count 37 316 353 % within Gender 10.5% 89.5% 100.0% Total Count 42 364 406 % within Gender 10.3% 89.7% 100.0% Synergy Gender Male Count 7 22 29 % within Gender 24.1% 75.9% 100.0% Female Count 7 85 92 % within Gender 7.6% 92.4% 100.0% Total Count 14 107 121 % within Gender 11.6% 88.4% 100.0% Yoga in Daily Gender Male Count 3 12 15 Life % within Gender 20.0% 80.0% 100.0% Female Count 10 76 86 % within Gender 11.6% 88.4% 100.0% Total Count 13 88 101 % within Gender 12.9% 87.1% 100.0%

These figures need to be interpreted with caution given that the proportion of left- handedness of men in Australia is unknown. Additionally, the numbers of participants in some of these sub-categories were low (eg; for Vinyasa Flow), therefore those figures may be unreliable.

4. Results

4.1.11. Height, weight and Body Mass Index (BMI)

Participants were required to enter their height (cm) and weight (kg), from which BMI was calculated. It was thought that average BMI may vary by style of yoga, and if cross- tabulated with other variables may provide insight as to the characteristics of participants or the effect of yoga practice.

A ‘pop-up’ imperial to metric converter was provided to assist participants to make any necessary conversion. Tables 4.1.21 and 4.1.22 below show mean BMI for all participants (both students and teachers) by style group, selected styles, and gender respectively.

Both women and men who practised the more dynamic styles (e.g. Yoga Synergy, Ashtanga and Bikram) demonstrated the lowest BMIs, followed by Yoga in Daily Life, and Iyengar.

Table 4.1.21. Mean BMI by style group and gender

Style Group Gender Mean N SD 1. Meditation Male 23.44 25 2.830 Female 24.65 62 5.239 Total 24.30 87 4.691 2. General Male 24.08 114 3.766 Female 23.57 720 3.909 Total 23.64 834 3.891 3. Satyananda Male 24.53 51 2.752 Female 23.55 343 3.626 Total 23.68 394 3.538 4. Hatha Male 23.69 54 3.002 Female 23.44 407 3.658 Total 23.47 461 3.585 5. Iyengar Male 23.99 165 2.915 Female 22.79 804 3.301 Total 22.99 969 3.268 6. Dynamic Male 24.01 119 2.670 Female 21.84 501 2.843 Total 22.26 620 2.935 7. Others Male 24.62 21 3.827 Female 23.69 153 3.655 Total 23.80 174 3.678 8. Hybrid Male 21.50 4 1.915 Female 22.89 36 3.487 Total 22.75 40 3.372 Total Male 24.01 553 3.084 Female 23.07 3026 3.599 Total 23.22 3579 3.540

4. Results

Table 4.1.22. Mean BMI by selected styles and gender BMI Style Gender Mean N SD Ashtanga Male 23.80 41 2.786 Female 21.59 216 2.965 Total 21.95 257 3.042 Bikram Male 25.17 35 2.332 Female 22.28 123 2.892 Total 22.92 158 3.022 Contemporary Classical Male 24.04 28 2.701 Female 23.37 181 3.751 Total 23.46 209 3.629 Gita Male 27.00 12 5.063 Female 24.82 126 4.809 Total 25.01 138 4.852 Hatha Male 23.69 54 3.002 Female 23.44 407 3.658 Total 23.47 461 3.585 Iyengar Male 23.99 165 2.915 Female 22.79 804 3.301 Total 22.99 969 3.268 Satyananda Male 24.53 51 2.752 Female 23.55 343 3.626 Total 23.68 394 3.538 Synergy Male 23.07 28 2.448 Female 21.43 91 2.310 Total 21.82 119 2.435 Yoga in Daily Life Male 22.80 15 2.455 Female 23.00 80 3.639 Total 22.97 95 3.469

4. Results

4.1.12. Pregnancy

Participants were asked whether they were pregnant, or had been pregnant in the previous 12 months. As shown in Table 4.1.23, rates of pregnancy between teachers (5.0%) and students (3.9%) did not differ markedly. Pregnant students and teachers were most likely to be practising Iyengar or a dynamic form of yoga, along with some of the styles which were not able to be categorised in the ‘Others’ group.

Table 4.1.23. Rate of pregnancy by participant group and style group

Pregnant? Participant Group No Yes Total Student Style 1. Meditation Count 32 1 33 Group % within Style Group 97.0% 3.0% 100.0% 2. General Count 409 8 417 % within Style Group 98.1% 1.9% 100.0% 3. Satyananda Count 221 6 227 % within Style Group 97.4% 2.6% 100.0% 4. Hatha Count 366 11 377 % within Style Group 97.1% 2.9% 100.0% 5. Iyengar Count 693 37 730 % within Style Group 94.9% 5.1% 100.0% 6. Dynamic Count 446 23 469 % within Style Group 95.1% 4.9% 100.0% 7. Others Count 144 8 152 % within Style Group 94.7% 5.3% 100.0% 8. Hybrid Count 20 1 21 % within Style Group 95.2% 4.8% 100.0% Total Count 2331 95 2426 % within Style Group 96.1% 3.9% 100.0% Teacher Style 1. Meditation Count 59 3 62 Group % within Style Group 95.2% 4.8% 100.0% 2. General Count 423 17 440 % within Style Group 96.1% 3.9% 100.0% 3. Satyananda Count 173 7 180 % within Style Group 96.1% 3.9% 100.0% 4. Hatha Count 91 4 95 % within Style Group 95.8% 4.2% 100.0% 5. Iyengar Count 247 17 264 % within Style Group 93.6% 6.4% 100.0% 6. Dynamic Count 151 11 162 % within Style Group 93.2% 6.8% 100.0% 7. Others Count 28 2 30 % within Style Group 93.3% 6.7% 100.0% 8. Hybrid Count 18 1 19 % within Style Group 94.7% 5.3% 100.0% Total Count 1190 62 1252 % within Style Group 95.0% 5.0% 100.0%

4. Results

4.1.13. Marital status

The proportions of single and partnered (married or de-facto) teachers and students were consistent as shown in Table 4.1.24 below.

Table 4.1.24. Marital status by participant group

Participant Group Student Teacher Total Marital Single (never Count 833 422 1255 Status married, separated, divorced, widowed) % within Participant Group 32.6% 33.6% 33.0% Partnered (married Count 1708 828 2536 or defacto) % within Participant Group 66.9% 66.0% 66.6%

Other Count 12 5 17 % within Participant Group .5% .4% .4% Total Count 2553 1255 3808 % within Participant Group 100.0% 100.0% 100.0%

4. Results

4.1.14. Healthcare occupations

Participants were asked if they were (or had ever been) a healthcare practitioner, other than a yoga therapist. It was thought that there would be a greater prevalence of healthcare occupations amongst survey participants than the general population.

Healthcare occupations reported were coded into groups of similar disciplines as shown in Table 4.1.25 below, to establish the healthcare occupations most commonly found amongst survey participants.

About one quarter of teachers (26.7%) were employed in a healthcare occupation, compared to 14.0% of students. Students were most likely to be a nurse, while teachers were most likely to be a massage therapist or other bodywork practitioner.

Table 4.1.25. Healthcare occupations by participant group

Participant Group Student Teacher Total Healthcare 1. Doctor, Anaesthetist Count 29 3 32 Occupation % within Pt. Gp. 8.1% .9% 4.6% Group 2. Psychologist, Psychiatrist Count 24 33 57 % within Pt. Gp. 6.7% 9.8% 8.2% 3. Physiotherapist, Occ Therapist, Count 27 28 55 Osteopath, Chiropractor, Sports Therapist % within Pt. Gp. 7.5% 8.3% 7.9% 4. Naturopath, Herbal Med, Trad Chinese Count 37 42 79 Med, Acupuncturist, Homeopath % within Pt. Gp. 10.3% 12.5% 11.3% 5. Nurse, Midwife, Paramedic Count 120 47 167 % within Pt. Gp. 33.3% 13.9% 24.0% 6. Massage Therapist, Shiatsu Count 47 90 137 % within Pt. Gp. 13.1% 26.7% 19.7% 7. Social Worker, Counsellor Count 18 14 32 % within Pt. Gp. 5.0% 4.2% 4.6% 8. Ayurvedic, Reiki & Bowen practitioners, Count 27 55 82 Aromatherapist, Podiatrist, other Bodywork % within Pt. Gp. 7.5% 16.3% 11.8% 9. Pharmacist, Dentist, Radiographer, Count 23 14 37 Scientist, Technician % within Pt. Gp. 6.4% 4.2% 5.3% 10. Other Count 8 11 19 % within Pt. Gp. 2.2% 3.3% 2.7% Total Count 360 337 697 % within Pt. Gp. 100.0% 100.0% 100.0%

4. Results

4.1.15. Involvement in yoga or meditation related research

Participants were asked if they were, or had ever been, a researcher in a yoga or meditation related area. As shown in Table 4.1.26, 1.1% of students and 7.7% of teachers were, or had been involved in research, most commonly stress, back pain, depression, women’s health, mindfulness, other mental health, spirituality, psychology, philosophy, children’s health, and asthma (in order of frequency of mention).

Table 4.1.26. Involvement in yoga or meditation related research by participant group

Teacher or Student Student Teacher Total Yoga related No Count 2539 1167 3706 research % within Teacher 98.9% 92.3% 96.7% or Student Yes Count 28 98 126 % within Teacher 1.1% 7.7% 3.3% or Student Total Count 2567 1265 3832 % within Teacher 100.0% 100.0% 100.0% or Student

4.1.16. Supply of goods and services to the yoga community

Participants were asked if they were a supplier of goods or services to the yoga community. As shown in Table 4.1.27, 0.9% of students and 11.0% of teachers were suppliers, most commonly of yoga mats, books, CDs, clothing, props (e.g. blocks and belts), DVDs/videos, neti pots, bolsters/cushions, retreats /classes (e.g. meditation classes), oils, magazines, and herbs (in order of frequency of mention).

Table 4.1.27. Supply of goods and services to the yoga community by participant group

Teacher or Student Student Teacher Total Yoga related No Count 2544 1126 3670 services % within Teacher 99.1% 89.0% 95.8% or Student Yes Count 23 139 162 % within Teacher .9% 11.0% 4.2% or Student Total Count 2567 1265 3832 % within Teacher 100.0% 100.0% 100.0% or Student

4. Results

4.1.17. Religious or spiritual orientation

Participants were asked to select the option that best described their religious or spiritual orientation. It was thought this would differ between participants and the general population, and that it would also differ between students and teachers. Options provided were designed to compare with ABS data for Australia and world adherents data, as shown in Table 4.1.28 below.

Table 4.1.28. Religious or spiritual orientation by participant group

Participant Group Student Teacher Total Religious/spiritual Christianity (Catholic, Count 884 204 1088 orientation Anglican, Protestant, Orthodox, etc) % within Pt. Gp. 35.7% 16.5% 29.3% Islam Count 1 1 2 % within Pt. Gp. .0% .1% .1% Hinduism Count 24 54 78 % within Pt. Gp. 1.0% 4.4% 2.1% Secular (non-religious, Count 610 104 714 atheist, agnostic) % within Pt. Gp. 24.6% 8.4% 19.3% Buddhism Count 147 122 269 % within Pt. Gp. 5.9% 9.9% 7.3% Chinese Traditional Count 5 2 7 % within Pt. Gp. .2% .2% .2% Indigenous (eg: Aboriginal) Count 3 2 5 % within Pt. Gp. .1% .2% .1% Judaism Count 50 18 68 % within Pt. Gp. 2.0% 1.5% 1.8% Spiritual/new age ( non Count 685 663 1348 -religious spiritual beliefs) % within Pt. Gp. 27.7% 53.7% 36.3% Other Count 66 64 130 % within Pt. Gp. 2.7% 5.2% 3.5% Total Count 2475 1234 3709 % within Pt. Gp. 100.0% 100.0% 100.0%

The religious orientation of both teachers and students was found to be quite different from the general population. While 68% of the population identified themselves as Christian in the 2002 Census, only 36% of students and 16% of teachers indicated they were ‘Christian’ in the yoga survey.

Conversely, 28% and 54% of students and teachers respectively said they held ‘spiritual but non-religious’ beliefs. In the same way, while Buddhism represents about 2% of the Australian population, about 6% of students and 10% of teachers said they held ‘Buddhist beliefs’.

The religious orientation of participants was then further investigated by years of practice, using the same groupings for years of regular practice developed earlier in the Demographic section. Tables 4.1.29 and 4.1.30 over the next two pages show the religious/spiritual orientation by years of regular practice of students and teachers in separate tables.

Note: figures may be unreliable in groupings where participant numbers are low

4. Results

Table 4.1.29. Religious or spiritual orientation of students by grouped years of regular practice

Years regular practice grouped 0-1 years 2-3 years 4-5 years 6-7 years 8-9 years 10-14 years 15-19 years 20-29 years 30+ years Total Religious Christianity (Catholic, Count 169 223 143 61 38 48 20 26 15 743 or spiritual Anglican, Protestant, % within Years regular 43.0% 37.2% 32.0% 27.9% 29.5% 30.0% 28.6% 28.3% 60.0% 34.8% orientation Orthodox, etc) practice grouped Islam Count 0 0 0 1 0 0 0 0 0 1 % within Years regular .0% .0% .0% .5% .0% .0% .0% .0% .0% .0% practice grouped Hinduism Count 3 5 2 1 0 6 1 1 0 19 % within Years regular .8% .8% .4% .5% .0% 3.8% 1.4% 1.1% .0% .9% practice grouped Secular (non-religious, Count 102 146 111 59 38 46 13 24 3 542 atheist, agnostic) % within Years regular 26.0% 24.4% 24.8% 26.9% 29.5% 28.8% 18.6% 26.1% 12.0% 25.4% practice grouped Buddhism Count 16 36 29 20 11 6 6 6 3 133 % within Years regular 4.1% 6.0% 6.5% 9.1% 8.5% 3.8% 8.6% 6.5% 12.0% 6.2% practice grouped Chinese Traditional Count 1 1 0 0 0 0 0 0 0 2 % within Years regular .3% .2% .0% .0% .0% .0% .0% .0% .0% .1% practice grouped Indigenous (eg: Count 2 0 1 0 0 0 0 0 0 3 Aboriginal) % within Years regular .5% .0% .2% .0% .0% .0% .0% .0% .0% .1% practice grouped Judaism Count 2 9 8 7 2 2 4 6 0 40 % within Years regular .5% 1.5% 1.8% 3.2% 1.6% 1.3% 5.7% 6.5% .0% 1.9% practice grouped Spiritual/new age (eg: Count 92 164 137 67 34 46 22 26 4 592 non-religious spiritual % within Years regular 23.4% 27.4% 30.6% 30.6% 26.4% 28.8% 31.4% 28.3% 16.0% 27.7% beliefs) practice grouped Other Count 6 15 16 3 6 6 4 3 0 59 % within Years regular 1.5% 2.5% 3.6% 1.4% 4.7% 3.8% 5.7% 3.3% .0% 2.8% practice grouped Total Count 393 599 447 219 129 160 70 92 25 2134 % within Years regular 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% practice grouped

4. Results

Table 4.1.30. Religious or spiritual orientation of teachers by grouped years of regular practice

Years regular practice grouped 0-1 years 2-3 years 4-5 years 6-7 years 8-9 years 10-14 years 15-19 years 20-29 years 30+ years Total Religious Christianity (Catholic, Count 3 17 34 20 21 33 18 17 20 183 or spiritual Anglican, Protestant, % within Years regular 17.6% 18.5% 18.3% 13.2% 17.1% 16.2% 14.6% 10.6% 25.0% 16.1% orientation Orthodox, etc) practice grouped Hinduism Count 2 4 6 8 5 8 5 9 4 51 % within Years regular 11.8% 4.3% 3.2% 5.3% 4.1% 3.9% 4.1% 5.6% 5.0% 4.5% practice grouped Secular (non-religious, Count 2 13 20 10 5 22 9 17 1 99 atheist, agnostic) % within Years regular 11.8% 14.1% 10.8% 6.6% 4.1% 10.8% 7.3% 10.6% 1.3% 8.7% practice grouped Buddhism Count 0 7 16 16 11 14 17 20 11 112 % within Years regular .0% 7.6% 8.6% 10.5% 8.9% 6.9% 13.8% 12.4% 13.8% 9.8% practice grouped Chinese Traditional Count 0 0 0 1 1 0 0 0 0 2 % within Years regular .0% .0% .0% .7% .8% .0% .0% .0% .0% .2% practice grouped Indigenous (eg: Count 0 0 1 0 0 0 0 1 0 2 Aboriginal) % within Years regular .0% .0% .5% .0% .0% .0% .0% .6% .0% .2% practice grouped Judaism Count 1 0 1 3 2 3 3 2 1 16 % within Years regular 5.9% .0% .5% 2.0% 1.6% 1.5% 2.4% 1.2% 1.3% 1.4% practice grouped Spiritual/new age (eg: Count 8 48 99 86 73 116 61 82 38 611 non-religious spiritual % within Years regular 47.1% 52.2% 53.2% 56.6% 59.3% 56.9% 49.6% 50.9% 47.5% 53.7% beliefs) practice grouped Other Count 1 3 9 8 5 8 10 13 5 62 % within Years regular 5.9% 3.3% 4.8% 5.3% 4.1% 3.9% 8.1% 8.1% 6.3% 5.4% practice grouped Total Count 17 92 186 152 123 204 123 161 80 1138 % within Years regular 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% practice grouped

4. Results

Interestingly, the proportion of ‘Christian’ students decreased with years of practice, from 43.0% to 27.9% between 1 and 7 years of practice. In the same period, the students who said they were ‘spiritual but non-religious’, increased from 23.4% to 30.6%. Also, during this time, those with ‘Buddhist beliefs’ increased from 4.1% to 9.1%.

The trends are shown in Figure 4.1.31 below. After 6-7 years of practice, the trend away from identifying with Christianity (the dark blue series on the graph, second from the back) appears to stabilize. However, also after 6-7 years of practice, participant numbers in each category became too low to be considered reliable, illustrated by the large spike (tall dark blue column at the right of the graph) with only 15 respondents making up this column.

In the case of those with non-religious spiritual beliefs (the light blue series at the very back of the graph), once again, the proportion of those participants increased after 6-7 years of practice. There were also too few participants in the Buddhism category after 6-7 years of practice to draw any conclusions.

Religious and spiritual orientation is discussed later in this report, however it is worth noting at this stage that this data does not necessarily indicate a cause and effect relationship between years of yoga practice and spiritual orientation, given that there could be other impacting variables, such as whether a person who is attracted to yoga is also a person attracted to non-religious spirituality.

Figure 4.1.31. Religious or spiritual orientation of students by grouped years of regular practice

60.0%

50.0%

40.0%

30.0% grouping 20.0%

10.0% Percentage of participants by year 0.0% Spriritual (n=592) Christianity (n=743) 0-1 years Secular, none (n=542) 2-3 years 4-5 years 6-7 years 8-9 years Buddhism (n=133) 10-14 15-19 years 20-29 30+ years Years of yoga practice years years

4. Results

In the case of teachers, differences between their initial beliefs and the Australian population, and the subsequent trends, while similar to the trends for students, were much more pronounced, as shown in Figure 4.1.32 below. Those who identified with Christianity decreased from 17.6% to 13.2% over 6-7 years of practice, non-religious spiritual beliefs increased from 47.1% to 59.3% over 8-9 years, and Buddhism reached 10.5% after 6-7 years.

Figure 4.1.32. Religious or spiritual orientation of teachers by grouped years of regular practice

60.0%

50.0%

40.0%

30.0% grouping 20.0%

10.0% Percentage of participants by year by year participants of Percentage 0.0% Spriritual (n=611) Christianity (n=183) 0-1 years Secular, none (n=99) 2-3 years 4-5 years 6-7 years Buddhism (n=112) 8-9 years 10-14 15-19 20-29 years years 30+ years Years of yoga practice years

4. Results

4.1.18. Level of education

Participants were asked to select the option that best described their highest level of education, as shown in Table 4.1.33 below. Levels of education did not differ markedly between students and teachers. Overall, 81.4% of students had a tertiary or post-tertiary qualification, compared to 79.5% of teachers. Students were slightly more likely to have a post-graduate qualification.

Table 4.1.33. Level of education by participant group

Participant Group Student Teacher Total Level of Secondary - up to year 11 Count 247 123 370 education % within Participant Group 9.7% 9.8% 9.7% Secondary - year 12 or Count 226 132 358 equivalent % within Participant Group 8.9% 10.5% 9.4%

Tertiary - diploma, degree Count 1226 631 1857 or equivalent % within Participant Group 48.1% 50.1% 48.7% Tertiary - post graduate Count 849 370 1219 % within Participant Group 33.3% 29.4% 32.0% Other Count 3 4 7 % within Participant Group .1% .3% .2% Total Count 2551 1260 3811 % within Participant Group 100.0% 100.0% 100.0%

4. Results

4.1.19. Employment status and industry

As shown in Table 4.1.34, participants were asked to select the option that best described their employment status.

Table 4.1.34. Employment status by participant group

Participant Group Student Teacher Total Employment Employed - part-time or Count 476 233 709 status casual % within Pt. Gp. 18.6% 18.4% 18.6% Employed - full-time Count 1263 284 1547 % within Pt. Gp. 49.4% 22.5% 40.5% Self-employed Count 365 573 938 % within Pt. Gp. 14.3% 45.4% 24.5% Student (including part-time Count 131 73 204 or casual employment) % within Pt. Gp. 5.1% 5.8% 5.3% Unemployed (looking for Count 32 11 43 work) % within Pt. Gp. 1.3% .9% 1.1% Retiree Count 137 36 173 % within Pt. Gp. 5.4% 2.9% 4.5% Not in work force (not looking Count 146 37 183 for work) % within Pt. Gp. 5.7% 2.9% 4.8% Other Count 8 16 24 % within Pt. Gp. .3% 1.3% .6% Total Count 2558 1263 3821 % within Pt. Gp. 100.0% 100.0% 100.0%

About half (49.4%) of students were employed full-time, with another 14.3% self-employed, and 18.6% employed part-time or casual. As you might expect, teachers were much more likely to be self-employed (45.4%), and therefore, less likely to be employed full-time (22.5%).

Participants who described their employment status as employed or self-employed, were also asked to select their main type of employment from a list as shown in Table 4.1.35 below.

Interestingly, 14.6% of students selected ‘healthcare’, consistent with the 14.0% of students who earlier in the survey indicated that they were (or had been) employed in a healthcare occupation.

The figures for teachers in this question should not be treated as reliable because many teachers commented that they did not know how to respond, given that their chosen profession, yoga teaching, was not listed in the list of industry groups. It was expected that teachers would select the self-employment, healthcare, or education categories, but the question only caused confusion and the results for teachers should thus be interpreted with caution.

4. Results

Table 4.1.35. Employment industry by participant group

Participant Group Student Teacher Total Employment Accounting Count 34 6 40 industry % within Participant Group 2.3% .7% 1.7% Administration and office Count 181 49 230 support % within Participant Group 12.1% 5.4% 9.5%

Automotive Count 6 0 6 % within Participant Group .4% .0% .2% Community Count 48 21 69 % within Participant Group 3.2% 2.3% 2.9% Construction and Count 21 9 30 architecture % within Participant Group 1.4% 1.0% 1.2% Customer service and Count 12 7 19 contact centre % within Participant Group .8% .8% .8% Defence and essential Count 11 2 13 services % within Participant Group .7% .2% .5% Education Count 181 130 311 % within Participant Group 12.1% 14.2% 12.9% Engineering Count 24 9 33 % within Participant Group 1.6% 1.0% 1.4% Executive Count 31 3 34 % within Participant Group 2.1% .3% 1.4% Financial services Count 39 7 46 % within Participant Group 2.6% .8% 1.9% Healthcare Count 219 263 482 % within Participant Group 14.6% 28.8% 20.0% Hospitality, travel and Count 43 12 55 tourism % within Participant Group 2.9% 1.3% 2.3% Human resources and Count 27 8 35 recruitment % within Participant Group 1.8% .9% 1.5% Insurance Count 4 3 7 % within Participant Group .3% .3% .3% IT and Count 93 28 121 telecommunications % within Participant Group 6.2% 3.1% 5.0% Legal Count 43 7 50 % within Participant Group 2.9% .8% 2.1% Logistics, transport and Count 2 3 5 supply % within Participant Group .1% .3% .2% Manufacturing Count 19 6 25 % within Participant Group 1.3% .7% 1.0% Marketing Count 46 16 62 % within Participant Group 3.1% 1.8% 2.6% Media, advertising, arts Count 100 31 131 and entertainment % within Participant Group 6.7% 3.4% 5.4% Personal and other Count 12 22 34 services % within Participant Group .8% 2.4% 1.4% PR and communications Count 25 6 31 % within Participant Group 1.7% .7% 1.3% Property Count 11 2 13 % within Participant Group .7% .2% .5% Retail Count 36 13 49 % within Participant Group 2.4% 1.4% 2.0% Sales Count 17 13 30 % within Participant Group 1.1% 1.4% 1.2% Scientific Count 64 10 74 % within Participant Group 4.3% 1.1% 3.1% Self-employment Count 8 77 85 % within Participant Group .5% 8.4% 3.5% Trades Count 13 6 19 % within Participant Group .9% .7% .8% Other Count 130 144 274 % within Participant Group 8.7% 15.8% 11.4% Total Count 1500 913 2413 % within Participant Group 100.0% 100.0% 100.0%

4. Results

4.1.20. Household income

Participants were asked to select the option that best described their total gross household income from all wage earners in the household. Table 4.1.36 and Figure 4.1.37 below show the total gross household income by participant group.

More than a quarter of students (26.6%) reported a household income of more than $110,000, while three quarters (76.1%) had a household income above $50,000. Teachers were more likely to have a lower household income, and twice as likely as their students to have a household income of $30,000 or less.

Table 4.1.36. Total gross household income by participant group

Participant Group Student Teacher Total Household Less than $30,000 Count 215 247 462 income % within Participant Group 8.8% 20.4% 12.6% $30,000 - $49,999 Count 369 243 612 % within Participant Group 15.1% 20.1% 16.7% $50,000 - $69,999 Count 460 225 685 % within Participant Group 18.8% 18.6% 18.7% $70,000 - $89,999 Count 394 169 563 % within Participant Group 16.1% 14.0% 15.4% $90,000 - $109,999 Count 356 134 490 % within Participant Group 14.6% 11.1% 13.4% More than $110,000 Count 650 193 843 % within Participant Group 26.6% 15.9% 23.1% Total Count 2444 1211 3655 % within Participant Group 100.0% 100.0% 100.0%

Figure 4.1.37. Total gross household income by participant group

Participant Group 20% Student (n=2444) Teacher (n=1211)

15%

10% Percentagerespondents of 5%

0% Less than $30,000 - $50,000 - $70,000 - $90,000 - More than $30,000 $49,999 $69,999 $89,999 $109,999 $110,000 Total gross household income

4. Results

As shown in Table 4.1.38 below, students reported a mean of 1.73 income earners in their household contributing to the household income, compared with 1.67 income earners for teachers.

Table 4.1.38. Mean number of wage earners in household by participant group g Std. Error Participant Group Mean of Mean N % of Total N Std. Deviation Student 1.73 .015 2121 66.6% .675 Teacher 1.67 .019 1064 33.4% .616 Total 1.71 .012 3185 100.0% .656

4. Results

4.1.21. Participant comments

At the end of each module of questions in the survey, participants were given the opportunity to write an anecdotal comment. Comments were not intended to be analysed in the data, but to be used in a de-identified form by way of illustration of themes in the data, and in some cases, by way of inspiration. A selection of typical comments is provided throughout this report, commencing below in Table 4.1.39.

Table 4.1.39. Participant comments to the demographic module

42 year old female I am wondering why you have separated yoga and meditation? Are they not part of the same practice? Does one exclude the other? I have practised for nearly 20 years and find it interesting the styles of yoga available now seem to be classified as the types of yoga! I don't think that some forms of yoga these days are anything but the physical practice of asana! Raja, Hatha, Jnana, Bhakti and Karma yoga is where the practice of true yoga varies! I think this is where yoga today is loosing its authenticity. The yoga conversations now are "what yoga do you do?" There the judgements begin.

43 year old female With respect to religious/spiritual orientation I would have answered atheist a few years ago, however with the practice of yoga I am developing a spiritual side.

47 year old male The health benefits are obvious however the perceived spiritual path is not. There can be a good deal of self-hypnosis and group agreement that can be dangerous for less aware people. The danger is when the teachings, teacher or practice do not continue to evolve. This is the main reason we are alive. The ego of the leader is the problem.

57 year old female I grew up in a Christian world. However I am developing my own philosophy based on teachings of truth rather than the teachings of a specific religion. This includes spiritualism but is not confined by it.

35 year old female Yoga assists me to manage periodical depression. It assists me with increasing my flexibility that in turn helps manage my ongoing podiatry problems. Yoga philosophy helps me to develop new and stronger values that I am then able to pass on to my two young boys. As I age, I find it increasingly valuable to use spiritual teachings to guide me through the maze of day-to-day life. For this alone yoga is an invaluable resource in my daily life.

38 year old female The current popularity of yoga is both disappointing and encouraging. I know that when I first discovered yoga (at the age of 14), I only did it because my mum did and I felt it would help my body to look better! It is far more than the physical postures and I only hope that many of those who are drawn to yoga for the physical/trendy reasons, realise that it is a complex philosophical approach to life that has few equals. I have often 'left' yoga for many reasons (too busy, disappointed with a teacher or style, or just no reason at all), but I have always come back to the fold because it works. Pure and simple.

40 year old male The religion question was a bit difficult. I was born Jewish but don't identify with the religious dogma of it anymore. I am more Buddhist, but again don't like to fall into its dogma. I see the truth in all religions and honour all of them without loosing myself in their ideologies. So I can't place myself in any of these boxes. Especially spirituality because I have a religious attitude.

33 year old female I had no strong spiritual philosophies until I developed a deep yoga practice. I do not describe myself as having new age spiritual beliefs because yoga is most definitely not new age. My spirituality is entirely based on my yoga practice and uncovering my essential nature.

4. Results

4.2. Practice characteristics of respondents

4.2.1. Session frequency Participants were asked to select the option that best described how often they had practised yoga or meditation in the previous 12 months, whether in class (supervised), at home, or elsewhere (unsupervised).

Table 4.2.1 and Figure 4.2.2 below compare the session frequency by participant group.

Table 4.2.1. Session frequency by participant group

Participant Group Student Teacher Total Session 7 or more sessions Count 87 270 357 frequency a week % within 3.5% 22.1% 9.6% Participant Group 5-6 sessions a week Count 197 415 612 % within 7.9% 34.0% 16.5% Participant Group 3-4 sessions a week Count 602 371 973 % within 24.1% 30.4% 26.2% Participant Group 1-2 sessions a week Count 1413 148 1561 % within 56.6% 12.1% 42.0% Participant Group less than weekly Count 148 12 160 % within 5.9% 1.0% 4.3% Participant Group less than monthly Count 37 4 41 % within 1.5% .3% 1.1% Participant Group not at all Count 13 1 14 % within .5% .1% .4% Participant Group Total Count 2497 1221 3718 % within 100.0% 100.0% 100.0% Participant Group

4. Results

Figure 4.2.2. Session frequency by participant group

Participant Group 60% Student (n=2497) Teacher (n=1221)

50%

40%

30%

20% Percent of participant group participant Percent of

10%

0% 7 or more 5-6 3-4 1-2 less than less than not at all sessions sessions sessions sessions weekly monthly a week a week a week a week Session frequency

More than half of students (56.6%) practised once or twice a week, while about the same proportion of teachers (56.1%) practised 5-7 times a week (daily or nearly daily). Most teachers (86.5%) practised at least every second day.

This is relevant in comparisons between teachers and students throughout these results. In addition to the vocational interest of teachers in yoga teaching, any differences between the responses of teachers and students shed light on the effects of more years of regular practice and a higher frequency of practice amongst teachers.

Practice session frequency was also compared by style group and by selected styles as shown in Tables 4.2.3 and 4.2.4 below.

4. Results

Table 4.2.3. Session frequency by participant group and style group

Participa Style Group nt Group 1. Meditation 2. General 3. Satyananda 4. Hatha 5. Iyengar 6. Dynamic 7. Others 8. Hybrid Total Student Session 7 or more sessions Count 5 21 16 6 19 12 1 0 80 frequency a week % within Style Group 15.6% 5.1% 7.3% 1.6% 2.6% 2.6% .7% .0% 3.4% 5-6 sessions a week Count 7 19 23 24 51 60 8 0 192 % within Style Group 21.9% 4.6% 10.5% 6.6% 7.1% 13.0% 5.6% .0% 8.1% 3-4 sessions a week Count 5 76 47 73 197 167 16 1 582 % within Style Group 15.6% 18.6% 21.4% 19.9% 27.5% 36.3% 11.2% 4.8% 24.6% 1-2 sessions a week Count 15 246 126 236 405 188 101 19 1336 % within Style Group 46.9% 60.1% 57.3% 64.5% 56.5% 40.9% 70.6% 90.5% 56.4% less than weekly Count 0 35 7 19 35 26 13 1 136 % within Style Group .0% 8.6% 3.2% 5.2% 4.9% 5.7% 9.1% 4.8% 5.7% less than monthly Count 0 9 1 7 8 4 3 0 32 % within Style Group .0% 2.2% .5% 1.9% 1.1% .9% 2.1% .0% 1.4% not at all Count 0 3 0 1 2 3 1 0 10 % within Style Group .0% .7% .0% .3% .3% .7% .7% .0% .4% Total Count 32 409 220 366 717 460 143 21 2368 % within Style Group 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% Teacher Session 7 or more sessions Count 42 92 49 12 52 13 4 5 269 frequency a week % within Style Group 71.2% 21.6% 28.3% 13.3% 20.1% 8.4% 13.8% 27.8% 22.2% 5-6 sessions a week Count 7 126 68 20 109 70 9 3 412 % within Style Group 11.9% 29.6% 39.3% 22.2% 42.1% 45.2% 31.0% 16.7% 34.1% 3-4 sessions a week Count 7 140 37 38 69 59 10 7 367 % within Style Group 11.9% 32.9% 21.4% 42.2% 26.6% 38.1% 34.5% 38.9% 30.4% 1-2 sessions a week Count 2 61 16 19 25 12 6 3 144 % within Style Group 3.4% 14.3% 9.2% 21.1% 9.7% 7.7% 20.7% 16.7% 11.9% less than weekly Count 1 3 3 1 4 0 0 0 12 % within Style Group 1.7% .7% 1.7% 1.1% 1.5% .0% .0% .0% 1.0% less than monthly Count 0 3 0 0 0 1 0 0 4 % within Style Group .0% .7% .0% .0% .0% .6% .0% .0% .3% not at all Count 0 1 0 0 0 0 0 0 1 % within Style Group .0% .2% .0% .0% .0% .0% .0% .0% .1% Total Count 59 426 173 90 259 155 29 18 1209 % within Style Group 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

4. Results

Table 4.2.4. Session frequency by participant group and selected styles

Style Participant Contemporary Yoga in Group Ashtanga Bikram Classical Gita Hatha Iyengar Satyananda Synergy Daily Life Student Session 7 or more sessions Count 4 5 4 1 6 19 16 3 4 frequency a week % within Style 2.1% 3.8% 3.8% 1.3% 1.6% 2.6% 7.3% 3.1% 6.1% 5-6 sessions a week Count 33 16 3 2 24 51 23 6 2 % within Style 17.6% 12.0% 2.9% 2.7% 6.6% 7.1% 10.5% 6.1% 3.0% 3-4 sessions a week Count 60 57 18 13 73 197 47 34 9 % within Style 31.9% 42.9% 17.1% 17.3% 19.9% 27.5% 21.4% 34.7% 13.6% 1-2 sessions a week Count 76 44 68 48 236 405 126 49 35 % within Style 40.4% 33.1% 64.8% 64.0% 64.5% 56.5% 57.3% 50.0% 53.0% less than weekly Count 13 8 8 7 19 35 7 5 14 % within Style 6.9% 6.0% 7.6% 9.3% 5.2% 4.9% 3.2% 5.1% 21.2% less than monthly Count 1 3 3 3 7 8 1 0 2 % within Style .5% 2.3% 2.9% 4.0% 1.9% 1.1% .5% .0% 3.0% not at all Count 1 0 1 1 1 2 0 1 0 % within Style .5% .0% 1.0% 1.3% .3% .3% .0% 1.0% .0% Total Count 188 133 105 75 366 717 220 98 66 % within Style 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% Teacher Session 7 or more sessions Count 6 0 15 15 12 52 49 3 13 frequency a week % within Style 8.8% .0% 14.9% 24.2% 13.3% 20.1% 28.3% 14.3% 39.4% 5-6 sessions a week Count 34 8 31 16 20 109 68 11 5 % within Style 50.0% 38.1% 30.7% 25.8% 22.2% 42.1% 39.3% 52.4% 15.2% 3-4 sessions a week Count 25 9 35 24 38 69 37 7 9 % within Style 36.8% 42.9% 34.7% 38.7% 42.2% 26.6% 21.4% 33.3% 27.3% 1-2 sessions a week Count 3 4 17 7 19 25 16 0 6 % within Style 4.4% 19.0% 16.8% 11.3% 21.1% 9.7% 9.2% .0% 18.2% less than weekly Count 0 0 0 0 1 4 3 0 0 % within Style .0% .0% .0% .0% 1.1% 1.5% 1.7% .0% .0% less than monthly Count 0 0 2 0 0 0 0 0 0 % within Style .0% .0% 2.0% .0% .0% .0% .0% .0% .0% not at all Count 0 0 1 0 0 0 0 0 0 % within Style .0% .0% 1.0% .0% .0% .0% .0% .0% .0% Total Count 68 21 101 62 90 259 173 21 33 % within Style 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

4. Results

4.2.2. Session length

Participants were asked to select the option that best described the average length of their practice sessions.

Table 4.2.5 and Figure 4.2.6 below compare the session length by participant group.

Table 4.2.5. Session length by participant group

Participant Group Student Teacher Total Session less than 15 minutes Count 26 7 33 length % within 1.0% .6% .9% Participant Group 15-25 minutes Count 134 93 227 % within 5.4% 7.6% 6.1% Participant Group 30-40 minutes Count 181 150 331 % within 7.3% 12.3% 8.9% Participant Group 45-55 minutes Count 314 189 503 % within 12.6% 15.5% 13.5% Participant Group 60-70 minutes Count 666 308 974 % within 26.7% 25.2% 26.2% Participant Group 75-85 minutes Count 351 151 502 % within 14.1% 12.3% 13.5% Participant Group 90-100 minutes Count 712 233 945 % within 28.6% 19.1% 25.5% Participant Group more than 100 minutes Count 106 92 198 % within 4.3% 7.5% 5.3% Participant Group Total Count 2490 1223 3713 % within 100.0% 100.0% 100.0% Participant Group

Session length was comparable between students and teachers, with the most popular session lengths being 60-70 minutes and 90-100 minutes. This finding is in line with the commercial availability of one hour, and one-and-a-half hour classes. Students were more likely than teachers to practice for 90-100 minutes, most likely a reflection of their attendance at these classes.

4. Results

Figure 4.2.6. Session length by participant group

Participant Group 30% Student (n=2490) Teacher (n=1223)

20%

10% Percent of participant group of participant Percent

0% less than 15-25 30-40 45-55 60-70 75-85 90-100 more 15 minutes minutes minutes minutes minutes minutes than 100 minutes minutes Session length

Practice session length was also compared by style group and selected styles as shown in Tables 4.2.7 and 4.2.8 below.

4. Results

Table 4.2.7. Session length by participant group and style group

Participa Style Group nt Group 1. Meditation 2. General 3. Satyananda 4. Hatha 5. Iyengar 6. Dynamic 7. Others 8. Hybrid Total Student Session less than 15 minutes Count 0 5 3 1 6 2 2 0 19 length % within Style Group .0% 1.2% 1.4% .3% .8% .4% 1.4% .0% .8% 15-25 minutes Count 7 25 20 25 34 6 5 1 123 % within Style Group 21.9% 6.1% 9.1% 6.8% 4.7% 1.3% 3.5% 4.8% 5.2% 30-40 minutes Count 5 31 28 32 47 13 10 2 168 % within Style Group 15.6% 7.6% 12.7% 8.8% 6.6% 2.8% 7.1% 9.5% 7.1% 45-55 minutes Count 5 64 38 47 72 33 29 3 291 % within Style Group 15.6% 15.7% 17.3% 12.9% 10.1% 7.2% 20.6% 14.3% 12.3% 60-70 minutes Count 6 146 51 114 169 77 59 3 625 % within Style Group 18.8% 35.8% 23.2% 31.2% 23.6% 16.7% 41.8% 14.3% 26.4% 75-85 minutes Count 4 48 38 57 113 51 21 4 336 % within Style Group 12.5% 11.8% 17.3% 15.6% 15.8% 11.1% 14.9% 19.0% 14.2% 90-100 minutes Count 4 84 39 83 226 240 13 8 697 % within Style Group 12.5% 20.6% 17.7% 22.7% 31.6% 52.2% 9.2% 38.1% 29.5% more than 100 minutes Count 1 5 3 6 49 38 2 0 104 % within Style Group 3.1% 1.2% 1.4% 1.6% 6.8% 8.3% 1.4% .0% 4.4% Total Count 32 408 220 365 716 460 141 21 2363 % within Style Group 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% Teacher Session less than 15 minutes Count 0 5 0 1 0 0 1 0 7 length % within Style Group .0% 1.2% .0% 1.1% .0% .0% 3.4% .0% .6% 15-25 minutes Count 13 39 17 7 8 1 2 3 90 % within Style Group 22.0% 9.2% 9.7% 7.8% 3.1% .6% 6.9% 16.7% 7.4% 30-40 minutes Count 5 62 40 18 15 4 4 1 149 % within Style Group 8.5% 14.6% 22.9% 20.0% 5.8% 2.6% 13.8% 5.6% 12.3% 45-55 minutes Count 20 78 38 12 22 9 4 5 188 % within Style Group 33.9% 18.3% 21.7% 13.3% 8.5% 5.8% 13.8% 27.8% 15.5% 60-70 minutes Count 14 125 38 28 57 32 7 2 303 % within Style Group 23.7% 29.3% 21.7% 31.1% 22.0% 20.6% 24.1% 11.1% 25.0% 75-85 minutes Count 0 50 17 8 36 33 4 2 150 % within Style Group .0% 11.7% 9.7% 8.9% 13.9% 21.3% 13.8% 11.1% 12.4% 90-100 minutes Count 3 51 18 14 80 55 6 5 232 % within Style Group 5.1% 12.0% 10.3% 15.6% 30.9% 35.5% 20.7% 27.8% 19.2% more than 100 minutes Count 4 16 7 2 41 21 1 0 92 % within Style Group 6.8% 3.8% 4.0% 2.2% 15.8% 13.5% 3.4% .0% 7.6% Total Count 59 426 175 90 259 155 29 18 1211 % within Style Group 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

4. Results

Table 4.2.8. Session length by participant group and selected styles

Style Participant Contemporary Yoga in Group Ashtanga Bikram Classical Gita Hatha Iyengar Satyananda Synergy Daily Life Student Session less than 15 minutes Count 1 0 2 3 1 6 3 0 0 length % within Style .5% .0% 1.9% 4.0% .3% .8% 1.4% .0% .0% 15-25 minutes Count 3 0 10 2 25 34 20 0 1 % within Style 1.6% .0% 9.5% 2.7% 6.8% 4.7% 9.1% .0% 1.5% 30-40 minutes Count 7 0 11 6 32 47 28 2 5 % within Style 3.7% .0% 10.5% 8.0% 8.8% 6.6% 12.7% 2.0% 7.6% 45-55 minutes Count 20 2 10 14 47 72 38 5 5 % within Style 10.6% 1.5% 9.5% 18.7% 12.9% 10.1% 17.3% 5.1% 7.6% 60-70 minutes Count 52 6 31 42 114 169 51 10 17 % within Style 27.7% 4.5% 29.5% 56.0% 31.2% 23.6% 23.2% 10.2% 25.8% 75-85 minutes Count 22 3 11 6 57 113 38 19 10 % within Style 11.7% 2.3% 10.5% 8.0% 15.6% 15.8% 17.3% 19.4% 15.2% 90-100 minutes Count 62 119 29 2 83 226 39 49 28 % within Style 33.0% 89.5% 27.6% 2.7% 22.7% 31.6% 17.7% 50.0% 42.4% more than 100 minutes Count 21 3 1 0 6 49 3 13 0 % within Style 11.2% 2.3% 1.0% .0% 1.6% 6.8% 1.4% 13.3% .0% Total Count 188 133 105 75 365 716 220 98 66 % within Style 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% Teacher Session less than 15 minutes Count 0 0 2 0 1 0 0 0 0 length % within Style .0% .0% 2.0% .0% 1.1% .0% .0% .0% .0% 15-25 minutes Count 0 0 9 8 7 8 17 1 0 % within Style .0% .0% 8.9% 12.9% 7.8% 3.1% 9.7% 4.8% .0% 30-40 minutes Count 1 0 12 11 18 15 40 0 5 % within Style 1.5% .0% 11.9% 17.7% 20.0% 5.8% 22.9% .0% 15.2% 45-55 minutes Count 4 0 15 15 12 22 38 3 5 % within Style 5.9% .0% 14.9% 24.2% 13.3% 8.5% 21.7% 14.3% 15.2% 60-70 minutes Count 10 1 31 19 28 57 38 7 9 % within Style 14.7% 4.8% 30.7% 30.6% 31.1% 22.0% 21.7% 33.3% 27.3% 75-85 minutes Count 17 2 15 4 8 36 17 4 3 % within Style 25.0% 9.5% 14.9% 6.5% 8.9% 13.9% 9.7% 19.0% 9.1% 90-100 minutes Count 19 18 13 4 14 80 18 5 9 % within Style 27.9% 85.7% 12.9% 6.5% 15.6% 30.9% 10.3% 23.8% 27.3% more than 100 minutes Count 17 0 4 1 2 41 7 1 2 % within Style 25.0% .0% 4.0% 1.6% 2.2% 15.8% 4.0% 4.8% 6.1% Total Count 68 21 101 62 90 259 175 21 33 % within Style 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

4. Results

4.2.3. Reasons for beginning and continuing

Participants were asked to select the options that best described their reasons for beginning and continuing their yoga practice. It was possible to select multiple reasons. The groupings of reasons were informed by other yoga studies in the literature review and the consultative process with the yoga community.

Figure 4.2.9 below shows a screenshot of this question.

Figure 4.2.9. Screenshot of the reasons for beginning and continuing question

It was thought that the reasons for beginning would indicate pre-conceptions and expectations of yoga practice; while reasons for continuing, if different, would indicate whether those expectations were met or exceeded. It was also thought that any differences between the reasons given for beginning and those for continuing would suggest ways in which participants might ‘discover’ aspects of yoga they did not expect.

Table 4.2.10 below shows the reasons for beginning, continuing, and percentage change by participant group.

4. Results

Table 4.2.10. Reasons for beginning and continuing by participant group

Student Teacher Beginning Continuing % change Beginning Continuing % change Trendy, Count 64 11 27 6 in vogue % 2.6% 0.5% 18% 2.3% 0.5% 22% Increase health Count 1,767 1,962 749 872 and fitness % 71.9% 82.3% 114% 62.8% 73.5% 117% Increase Count 1,732 2,061 636 799 flexibility, % muscle tone 70.5% 86.5% 123% 53.4% 67.4% 126% Reduce stress Count 1,434 1,893 588 827 or anxiety % 58.4% 79.4% 136% 49.3% 69.7% 141% Specific health or Count 485 505 230 238 medical reason % 19.7% 21.2% 107% 19.3% 20.1% 104% Pregnancy, Count 79 91 47 74 childbirth % 3.2% 3.8% 119% 3.9% 6.2% 158% Menopause or Count 83 187 27 135 other women’s % health 3.4% 7.8% 232% 2.3% 11.4% 503% Spiritual path Count 463 1,017 440 992 % 18.9% 42.7% 226% 36.9% 83.6% 227% Personal Count 723 1,410 442 952 development % 29.4% 59.1% 201% 37.1% 80.3% 216% Enhance Count 268 468 116 232 performance % in other activity 10.9% 19.6% 180% 9.7% 19.6% 201% Other Count 127 138 104 90 % 5.2% 5.8% 112% 8.7% 7.6% 87% Total Count 2,456 2,384 1,192 1,186

4. Results

The two reasons most commonly given for starting yoga by students were ‘increase health/fitness’ and ‘increase flexibility/muscle tone’, both with about 70% of respondents. In fact, respondents who selected one of these reasons usually also selected the other. These responses increased to 82% and 86% respectively as reasons for continuing, confirming that yoga is primarily seen as a physical discipline and exceeds expectations in that respect.

However, ‘to reduce stress or anxiety’ was given by 58% of students as a reason for beginning yoga practice; increasing to 79% as a reason for continuing, nearly as frequently as the physical reasons for practice described above.

Even greater differences were found in the options described as ‘spiritual path’ and ‘personal development’. While only 19% of students initially saw yoga as a spiritual practice, this more than doubled to 43% once practising. Similarly, 29% initially saw yoga as a form of personal development, increasing to 59% as a reason for continuing to practice, suggesting that people discover these things about yoga through continuing practice. Teachers were more aware of yoga’s spiritual and personal development path when beginning (before they became a teacher), but still a large proportion of teachers only found these things relevant once practising.

Also noteworthy, 20% of students said they had a specific health or medical reason for starting yoga, remaining steady at 21% as a reason for continuing, suggesting that expectations of yoga practice being able to assist in the management and treatment of health concerns and medical conditions were met.

Another area of interest was women’s health, with the proportion of students expecting/finding yoga to assist in addressing symptoms of menopause and pre-menstrual syndrome doubling from about 3% to 8% once practising.

Figures 4.2.11 and 4.2.12 below compare the reasons for beginning and continuing for students and teachers (on separate graphs).

4. Results

Figure 4.2.11. Reasons for beginning and continuing: Students

90%

80%

70%

60%

50%

40%

30%

20% Percentage of respondents 10%

Tre In n cre In dy, in vo cre R e S ase d pe Pre ase uce Menopaus he ci g Spi f fi na Personal development g a le stre c En ue l xib h n ri th e cy, tu Ot ss al al h a ili pa ance othe h nd ty o th/me c e e , r h , r fitne muscl a il womens th n d xi di bi Beginning (n=2456) ss ety ca rt e h r t l re a o ct Continuing (n=2384) ne a h son ea ivity lth

Figure 4.2.12. Reasons for beginning and continuing: Teachers

90%

80%

70%

60%

50%

40%

30%

20% Percentage of respondents 10%

T r Inc e Incre ndy r Redu e S , in vo as p P e h as ecific heal r M e flexibility, musce egn e S eal s nopause, womenpi P gu tr an r erson Enhance other activity th a e itua O e ss or cy, ch the nd fi th l p al /medi ath develo r a ild tn nxiety es bi c c rt Beginning (n=1192) s le t al h p s ment Continuing (n=1186) one reas health on

4. Results

4.2.4. Influences to begin practising

Participants were asked to select the options that best described how (else) they were influenced to begin practising. Again, it was possible to select multiple reasons.

Table 4.2.13 and Figure 4.2.14 below show the influences by participant group.

Table 4.2.13. Influences to begin practising

Participant Group Student Teacher Total Influences Media (TV, magazine, Count 327 118 445 to begin newspaper) % within a 13.9% 10.6% practising participant group Recommendation Count 1366 617 1983 from friend or family % within 58.3% 55.3% participant group Referred by GP or Count 240 67 307 health practitioner % within 10.2% 6.0% participant group Books, journals Count 585 363 948 % within 24.9% 32.6% participant group Suggestion of coach Count 49 27 76 or personal trainer % within 2.1% 2.4% participant group Other Count 380 212 592 % within 16.2% 19.0% participant group Total Count 2345 1115 3460 Percentages and totals are based on respondents. a. Dichotomy group tabulated at value 1.

Figure 4.2.14. Influences to begin practising

60%

50%

40%

30%

20% Percentage of respondents 10%

Media (TV, Recommendation magazine, Referred by GP from friend or newspaper) or health Books, journals family Suggestion of practitioner coach or Other Students (n=2345) personal trainer Teachers (n=1115) Influences

4. Results

Personal recommendation from a friend or family member was the most common influence, followed by books and journals. There were similar responses across students and teachers. Of the 754 respondents who selected ‘Other’, the most common influences (in order of frequency) were:

Personal interest Available at the gym Attended a class at school Recommendation of a teacher Available at work Recommendation of a friend Recommendation of a parent Spiritual interest As a result of a trip to, or interest in, India Been interested since childhood Curiosity

4. Results

4.2.5. Years since first started practising

Participants were asked how many years ago they first started practising and since then, about how many years had they practised regularly.

As shown in Figures 4.2.15 and 4.2.16 below, both students and teachers had a tendency to ‘round off’ their responses to the nearest five years, resulting in the spikes at 10, 15, 20, 25, 30, 35 and 40 years.

Figure 4.2.15. Years since starting: Students

250

200

150

Frequency 100

Mean =9.17 Std. Dev. =9.343 N =2,268 0 0 10 20 30 40 50 Years since starting

Figure 4.2.16. Years since starting: Teachers

100

Frequency 40

Mean =16.93 Std. Dev. =10.751 N =1,174 0 0 10 20 30 40 50 Years since starting

4. Results

Despite the five-yearly spikes, the ‘box and whisker’ plot shown in Figure 4.2.17 below provides an alternate view of the distribution of values. The solid box represents 68% of the participants in each group (one standard deviation), while the whisker lines represent 95% of the participants in each group (two standard deviations), and the ‘outliers’ the ‘extreme’ values falling outside of the 95% of respondents. The reference number next to each outlier is the case number in the data file and therefore not relevant here.

The mean of years since starting for students was 9.17 years, while for teachers it was 16.93 years, a difference of nearly eight years.

Figure 4.2.17. Years since starting by participant group

611 50 928 3,468 1,691

1,1033,516 3,593 1,423 3,0923,154 40 3,423 1,906 2,085 713 1,002 6133,029 1,187 848 30 2,6333,635 3,184 3,034 3,147 3,500 2,370 2,106

20 Years since starting

Student Teacher Participant group

4. Results

Years since starting were also grouped into two and five year intervals (two year intervals up to nine years and five year intervals thereafter), designed to eliminate the effect of the spikes in participant responses for better comparison between participant groups.

Table 4.2.18 and Figure 4.2.19 below show years since starting (grouped) by participant group.

Table 4.2.18. Years since starting (grouped) by participant group

Participant Group Student Teacher Total Years 0-1 years Count 307 5 312 since % within Participant Group 13.5% .4% 9.1% starting 2-3 years Count 426 45 471 grouped % within Participant Group 18.8% 3.8% 13.7% 4-5 years Count 421 106 527 % within Participant Group 18.6% 9.0% 15.3% 6-7 years Count 221 102 323 % within Participant Group 9.7% 8.7% 9.4% 8-9 years Count 136 117 253 % within Participant Group 6.0% 10.0% 7.4% 10-14 years Count 272 217 489 % within Participant Group 12.0% 18.5% 14.2% 15-19 years Count 118 130 248 % within Participant Group 5.2% 11.1% 7.2% 20-29 years Count 214 226 440 % within Participant Group 9.4% 19.3% 12.8% 30+ years Count 153 226 379 % within Participant Group 6.7% 19.3% 11.0% Total Count 2268 1174 3442 % within Participant Group 100.0% 100.0% 100.0%

Figure 4.2.19. Years since starting (grouped) by participant group

Participant Group 20% Student (n=2268) Teacher (n=1174)

15%

10% Percent of participant group 5%

0% 0-1 2-3 4-5 6-7 8-9 10-14 15-19 20-29 30+ years years years years years years years years years Years since starting grouped

4. Results

4.2.6. Years of regular practice

Figures 4.2.20 and 4.2.21 below show the years of regular practice of students and teachers.

Figure 4.2.20. Years of regular practice: Students

400

300

200 Frequency

100

Mean =5.62 Std. Dev. =5.963 N =2,205 0 0 10 20 30 40 Years of regular practice

Figure 4.2.21. Years of regular practice: Teachers

120

100

60 Frequency

Mean =12.08 Std. Dev. =8.98 N =1,164 0 0 10 20 30 40 Years of regular practice

4. Results

The box and whisker plot shown in Figure 4.2.22 below shows the distribution of values around the mean of the years of regular practice of both students and teachers, once again with outliers (extreme values) shown. The reference number next to each outlier is the case number in the data file and therefore not relevant here.

Figure 4.2.22. Years of regular practice by participant group

3,468 939 811 2,369 1,103 3,084 1,618 1,049 40 1,114 1,2983,668 2,349 614 217 2,223 430 2,866 2,794 3,423 3,029 1,038 2,265 1,598 2,686 30 1,042 2,633 429 3,8002,052 1,623 482 1,210 481 1,254 3,802 3,7613,821 20 3,816 3,826 2,530 3,154 2,506 3,775 Years regular practice 3,832 3,557 3,394

Student Teacher Participant group

The mean of years of regular practice for students was 5.62, while for teachers it was 12.08, a difference of 6.5 years.

Once again, years of regular practice were grouped into two and five year intervals (two year intervals up to nine years and five year intervals thereafter), designed to eliminate the effect of the spikes in participant responses for better comparison between participant groups.

4. Results

Table 4.2.23 and Figure 4.2.24 below show years of regular practice (grouped) by participant group.

Table 4.2.23. Years of regular practice (grouped) by participant group

Participant Group Student Teacher Total Years 0-1 years Count 404 17 421 regular % within Participant Group 18.3% 1.5% 12.5% practice 2-3 years Count 628 97 725 grouped % within Participant Group 28.5% 8.3% 21.5% 4-5 years Count 461 191 652 % within Participant Group 20.9% 16.4% 19.4% 6-7 years Count 226 154 380 % within Participant Group 10.2% 13.2% 11.3% 8-9 years Count 131 125 256 % within Participant Group 5.9% 10.7% 7.6% 10-14 years Count 165 211 376 % within Participant Group 7.5% 18.1% 11.2% 15-19 years Count 70 124 194 % within Participant Group 3.2% 10.7% 5.8% 20-29 years Count 94 163 257 % within Participant Group 4.3% 14.0% 7.6% 30+ years Count 26 82 108 % within Participant Group 1.2% 7.0% 3.2% Total Count 2205 1164 3369 % within Participant Group 100.0% 100.0% 100.0%

Figure 4.2.24. Years of regular practice (grouped) by participant group

Participant Group 30% Student (n=2205) Teacher (n=1164)

20%

10% Percent of participant group

0% 0-1 2-3 4-5 6-7 8-9 10-14 15-19 20-29 30+ years years years years years years years years years Years of regular practice grouped

4. Results

4.2.7. Components of practice

Participants were asked to estimate the amount of time typically devoted to components of their practice sessions in minutes. Components suggested were:

Asana (postures) Vinyasa (dynamic sequences of postures) Pranayama (breathing techniques) Meditation Relaxation, stress management Discussion, instruction Other

Tables 4.2.25 to 4.2.29 over the next five pages show the mean number of minutes devoted to each component of practice, firstly by participant group, then by style group, then by selected styles.

A total of 2357 students reported 3279 hours of practice, with a mean of 83.5 minutes per practice session, while 1194 teachers reported 1900 hours of practice, with a mean of 95.5 minutes per practice session.

As shown in the tables, both students and teachers spent most of their time practising asana and vinyasa. Teachers spent more time overall on the practice of pranayama and meditation than students. Students were more likely to participate in discussion, presumably facilitated by their teachers.

Both students and teachers practising Iyengar yoga and the more dynamic styles of yoga spent considerably more time on the practice of asana. Students and teachers of Satyananda yoga and Yoga in Daily Life generally spent more time in meditation (with the exception of the meditative styles in Group 1), and also more time on relaxation and stress reduction techniques than other styles.

Overall, 61% of the time students spent practising was devoted to the physical practices; the other 39% to pranayama, meditation, and relaxation. For teachers, asana and vinyasa accounted for 57% of the time spent practising.

4. Results

Table 4.2.25. Components of practice by participant group

Vinyasa Relaxation, Participant Asana (dynamic Pranayama stress Discussion, Group (postures) sequences) (breathing) Meditation management instruction Other Total time Student Mean 40.71 10.05 7.56 8.43 9.23 5.32 2.15 83.46 N 2357 2357 2357 2357 2357 2357 2357 2357 Std. Deviation 22.722 16.361 8.929 11.207 8.998 8.392 7.774 34.238 Teacher Mean 40.72 9.86 11.07 16.75 10.31 3.83 2.96 95.50 N 1194 1194 1194 1194 1194 1194 1194 1194 Std. Deviation 24.609 15.244 12.142 20.101 9.457 14.624 9.887 47.407 Total Mean 40.72 9.99 8.74 11.23 9.59 4.82 2.42 87.51 N 3551 3551 3551 3551 3551 3551 3551 3551 Std. Deviation 23.370 15.992 10.257 15.317 9.168 10.914 8.550 39.567

4. Results

Table 4.2.26. Components of practice by style group: Students

Vinyasa Relaxation, Participant Asana (dynamic Pranayama stress Discussion, Group Style Group (postures) sequences) (breathing) Meditation management instruction Other Total time Student 1. Meditation Mean 25.81 5.63 5.06 15.47 5.06 4.06 3.44 64.53 N 32 32 32 32 32 32 32 32 Std. Deviation 19.761 8.206 3.555 15.625 7.370 10.734 8.076 26.780 2. General Mean 35.06 7.17 8.86 8.97 10.40 4.69 2.30 77.45 N 381 381 381 381 381 381 381 381 Std. Deviation 15.521 9.436 8.028 9.959 8.668 6.296 7.149 27.264 3. Satyananda Mean 32.19 6.53 9.51 11.44 16.57 3.57 2.79 82.59 N 217 217 217 217 217 217 217 217 Std. Deviation 13.649 9.782 6.335 10.419 9.805 5.772 12.718 30.467 4. Hatha Mean 36.21 7.19 8.05 8.64 11.11 4.64 2.75 78.58 N 352 352 352 352 352 352 352 352 Std. Deviation 16.209 9.127 6.272 9.796 8.732 6.396 8.238 26.382 5. Iyengar Mean 49.53 6.53 5.59 7.61 7.40 6.48 1.76 84.90 N 694 694 694 694 694 694 694 694 Std. Deviation 23.513 11.311 7.727 12.361 7.524 7.483 6.269 29.964 6. Dynamic Mean 46.29 22.90 8.23 7.49 6.32 5.45 1.51 98.20 N 439 439 439 439 439 439 439 439 Std. Deviation 29.771 27.408 12.720 11.927 9.515 12.337 7.267 47.894 7. Others Mean 31.85 8.45 7.82 6.70 9.59 6.91 3.22 74.53 N 120 120 120 120 120 120 120 120 Std. Deviation 17.396 10.966 7.967 6.538 7.780 11.473 8.273 30.915 8. Hybrid Mean 27.26 16.05 3.95 8.42 12.11 3.89 1.21 72.89 N 19 19 19 19 19 19 19 19 Std. Deviation 18.138 17.762 3.937 8.669 8.386 3.871 3.172 23.471

4. Results

Table 4.2.27. Components of practice by style group: Teachers

Vinyasa Relaxation, Participant Asana (dynamic Pranayama stress Discussion, Group Style Group (postures) sequences) (breathing) Meditation management instruction Other Total time Teacher 1. Meditation Mean 19.11 4.55 8.61 34.29 6.13 6.25 5.63 84.55 N 56 56 56 56 56 56 56 56 Std. Deviation 21.429 9.736 21.554 29.931 8.155 14.655 12.175 59.198 2. General Mean 34.11 8.37 10.63 17.92 10.49 3.20 3.78 88.51 N 417 417 417 417 417 417 417 417 Std. Deviation 18.494 11.192 10.104 21.545 9.052 10.610 10.889 43.820 3. Satyananda Mean 31.62 5.43 12.14 19.71 16.56 1.50 4.10 91.08 N 173 173 173 173 173 173 173 173 Std. Deviation 13.796 4.982 10.283 15.836 11.634 4.041 13.049 40.848 4. Hatha Mean 36.19 8.05 8.80 12.70 10.57 3.81 2.22 82.33 N 88 88 88 88 88 88 88 88 Std. Deviation 15.425 7.262 7.459 18.061 7.089 4.971 7.383 28.723 5. Iyengar Mean 61.59 7.42 12.76 12.64 7.46 5.17 1.31 108.34 N 254 254 254 254 254 254 254 254 Std. Deviation 25.734 13.386 12.524 17.125 7.669 23.559 4.674 48.549 6. Dynamic Mean 48.51 24.37 10.65 12.95 8.53 5.79 2.07 112.86 N 150 150 150 150 150 150 150 150 Std. Deviation 28.783 26.999 13.363 17.043 8.267 17.877 10.621 56.411 7. Others Mean 34.48 12.59 13.69 17.07 12.76 2.07 .86 93.52 N 29 29 29 29 29 29 29 29 Std. Deviation 21.354 12.861 23.218 17.347 12.435 3.900 2.696 50.521 8. Hybrid Mean 27.35 18.82 5.35 14.88 9.59 .71 2.24 78.94 N 17 17 17 17 17 17 17 17 Std. Deviation 19.931 19.648 5.219 27.832 5.568 2.024 3.945 40.999

4. Results

Table 4.2.28. Components of practice by selected styles: Students

Vinyasa Relaxation, Participant Asana (dynamic Pranayama stress Discussion, Group Style (postures) sequences) (breathing) Meditation management instruction Other Total time Student Ashtanga Mean 37.98 27.55 7.39 6.62 7.12 4.46 1.62 92.73 N 181 181 181 181 181 181 181 181 Std. Deviation 27.043 27.236 10.027 8.150 6.998 8.076 5.646 33.535 Bikram Mean 67.49 9.72 10.37 8.46 4.94 7.68 1.97 110.64 N 126 126 126 126 126 126 126 126 Std. Deviation 23.284 24.603 16.833 17.876 12.372 20.353 11.227 68.357 Contemporary Classical Mean 34.06 6.94 7.88 10.44 10.39 4.62 3.04 77.37 N 98 98 98 98 98 98 98 98 Std. Deviation 15.979 8.841 5.753 9.228 7.858 4.938 9.594 20.374 Gita Mean 31.16 5.51 7.26 7.03 8.96 4.68 2.99 67.58 N 69 69 69 69 69 69 69 69 Std. Deviation 10.851 7.334 4.344 9.373 6.916 3.783 6.101 16.875 Hatha Mean 36.21 7.19 8.05 8.64 11.11 4.64 2.75 78.58 N 352 352 352 352 352 352 352 352 Std. Deviation 16.209 9.127 6.272 9.796 8.732 6.396 8.238 26.382 Iyengar Mean 49.53 6.53 5.59 7.61 7.40 6.48 1.76 84.90 N 694 694 694 694 694 694 694 694 Std. Deviation 23.513 11.311 7.727 12.361 7.524 7.483 6.269 29.964 Satyananda Mean 32.19 6.53 9.51 11.44 16.57 3.57 2.79 82.59 N 217 217 217 217 217 217 217 217 Std. Deviation 13.649 9.782 6.335 10.419 9.805 5.772 12.718 30.467 Synergy Mean 39.59 32.77 7.56 7.89 6.38 5.29 1.14 100.62 N 94 94 94 94 94 94 94 94 Std. Deviation 31.134 27.205 9.720 7.949 10.302 4.066 3.917 37.613 Yoga in Daily Life Mean 42.50 5.39 11.48 11.16 12.10 2.95 1.29 86.87 N 62 62 62 62 62 62 62 62 Std. Deviation 12.635 6.627 10.201 9.877 5.621 3.655 3.256 19.780

4. Results

Table 4.2.29. Components of practice by selected styles: Teachers

Vinyasa Relaxation, Participant Asana (dynamic Pranayama stress Discussion, Group Style (postures) sequences) (breathing) Meditation management instruction Other Total time Teacher Ashtanga Mean 51.99 29.78 11.32 13.85 9.63 4.85 2.79 124.22 N 68 68 68 68 68 68 68 68 Std. Deviation 33.604 32.478 14.928 19.249 9.684 18.182 15.022 57.132 Bikram Mean 68.21 11.32 8.58 17.11 5.89 11.95 .26 123.32 N 19 19 19 19 19 19 19 19 Std. Deviation 18.143 22.101 3.656 26.942 5.065 27.706 1.147 75.747 Contemporary Classical Mean 34.26 10.15 8.87 20.25 9.66 2.11 3.63 88.93 N 101 101 101 101 101 101 101 101 Std. Deviation 19.136 14.318 9.643 32.155 6.455 3.860 10.390 44.572 Gita Mean 30.82 3.23 9.16 11.34 11.62 2.34 5.72 74.25 N 61 61 61 61 61 61 61 61 Std. Deviation 12.082 4.307 7.071 14.273 13.591 4.029 14.437 30.434 Hatha Mean 36.19 8.05 8.80 12.70 10.57 3.81 2.22 82.33 N 88 88 88 88 88 88 88 88 Std. Deviation 15.425 7.262 7.459 18.061 7.089 4.971 7.383 28.723 Iyengar Mean 61.59 7.42 12.76 12.64 7.46 5.17 1.31 108.34 N 254 254 254 254 254 254 254 254 Std. Deviation 25.734 13.386 12.524 17.125 7.669 23.559 4.674 48.549 Satyananda Mean 31.62 5.43 12.14 19.71 16.56 1.50 4.10 91.08 N 173 173 173 173 173 173 173 173 Std. Deviation 13.796 4.982 10.283 15.836 11.634 4.041 13.049 40.848 Synergy Mean 35.71 21.43 10.00 9.29 5.81 3.19 1.67 87.10 N 21 21 21 21 21 21 21 21 Std. Deviation 20.754 18.718 9.402 5.071 5.546 3.043 3.651 19.005 Yoga in Daily Life Mean 32.90 4.84 11.23 29.97 10.48 1.06 6.77 97.26 N 31 31 31 31 31 31 31 31 Std. Deviation 16.216 5.550 7.974 21.355 8.694 3.021 15.735 39.453

4. Results

Components of a typical practice session for students and teachers are shown in Figures 4.2.30 and 4.2.31 below (students and teachers shown separately).

Figure 4.2.30. Components of practice: Students (n=2357)

Asana (postures) Vinyasa (dynamic sequences) Pranayama (breathing) Meditation Relaxation, stress management Other Discussion, instruction 3% Discussion, instruction Relaxation, stress 6% Other management 11%

Asana (postures) 49%

Meditation 10%

Pranayama (breathing) 9% Vinyasa (dynamic sequences) 12%

Figure 4.2.31. Components of practice: Teachers (n=1194)

Asana (postures) Vinyasa (dynamic sequences) Pranayama (breathing) Meditation Relaxation, stress management Discussion, instruction Other 6% Discussion, instruction Relaxation, stress 3% management Other 11%

Asana (postures) 46% Meditation 13%

Pranayama (breathing) Vinyasa (dynamic 10% sequences) 11%

4. Results

The same components of practice are shown again in Figures 4.2.32 and 4.2.33 below, but this time according to a grouping of the number of minutes allocated to each component. For example, the purple series at the very front of the graph shows that between 21 and 30 minutes was the most common length of asana practice for both students and teachers.

Figure 4.2.32. Components of practice: Students (n=2357)

90% Asana 80% Instruction Pranayama 70% Meditation 60% Vinyasa

50% Relaxation Other 40%

30%

20%

Percentage of respondents Other 10% Relaxation Vinyasa 0% Meditation none 1-10 Pranayama 11-20 21-30 31-40 Instruction 41-50 51-60 61-70 Asana 71-80 Number of minutes 81-90 91+

Figure 4.2.33. Components of practice: Teachers (n=1194)

90% Asana

80% Instruction Pranayama 70% Meditation 60% Vinyasa

50% Relaxation Other 40%

30%

20%

Percentage of respondents Other 10% Relaxation Vinyasa 0% Meditation none 1-10 Pranayama 11-20 21-30 31-40 Instruction 41-50 51-60 61-70 Asana 71-80 Number of minutes 81-90 91+

4. Results

4.2.8. Other components and techniques of practice

Participants were also asked to indicate if they included the following elements in their practice. Multiple selections were possible from the following:

Kriyas (cleansing techniques) Bandhas (muscular locks directing energy) Mudras (subtle gestures directing energy) Prayers or bhajans (devotional songs) Study of yogic texts Attendance at workshops, satsang (discourses), seminars and retreats

Table 4.2.34 and Figure 4.2.35 below show other components of practice by participant group.

Table 4.2.34. Other components and techniques of practice by participant group

Participant Group Student Teacher Total Other Kriyas Count 463 477 940 componentsa % within participant group 32.3% 41.6% of practice Bandhas Count 765 816 1581 % within participant group 53.4% 71.2% Mudras Count 702 761 1463 % within participant group 49.0% 66.4% Prayers, bhajans Count 456 524 980 % within participant group 31.8% 45.7% Study of yogic texts Count 394 833 1227 % within participant group 27.5% 72.7% Workshops, Count 555 920 1475 seminars, retreats % within participant group 38.7% 80.3% Total Count 1433 1146 2579

Figure 4.2.35. Other components and techniques of practice by participant group

90%

80%

70%

60%

50%

40%

30%

20% Percentage of participant group 10%

Kriyas Bandhas Mudras Prayers, Bhajans Study of yogic texts Students (n=1433) Workshops, Teachers (n=1146) retreats Component of practice

4. Results

Teachers’ responses indicated higher integration of these techniques into their yoga practice. However, it is interesting to note that 39% and 34% of teachers didn’t practice bandhas and mudras respectively.

Also, this question was only attempted by 1433 of 2497 students (57%) compared to 1146 of 1223 teachers (94%) who submitted this module of the questionnaire. This suggests that the proportion of students who did not practice any of these techniques (and therefore chose not to, or were unable to, complete this question), may in fact have been considerably higher.

4. Results

4.2.9. Meditation techniques

Participants were asked to select the techniques they regularly used in meditation practice. It was possible to select multiple responses. Table 4.2.36 and Figure 4.2.37 below show the responses.

Table 4.2.36. Meditation techniques by participant group

Participant Group Student Teacher Total

Meditation a Breath, any form of Count 1832 1099 2931 techniques breathing % within participant group 94.4% 94.8% Mantra Count 753 743 1496 % within participant group 38.8% 64.1% Visualisation Count 1105 695 1800 % within participant group 57.0% 60.0% Healing techniques Count 307 360 667 % within participant group 15.8% 31.1% Prayer Count 256 305 561 % within participant group 13.2% 26.3% Focus on deity or guru Count 113 229 342 % within participant group 5.8% 19.8% Movement Count 247 282 529 % within participant group 12.7% 24.3% Sound Count 496 430 926 % within participant group 25.6% 37.1% Other Count 127 168 295 % within participant group 6.5% 14.5% Total Count 1940 1159 3099

Figure 4.2.37. Meditation techniques by participant group

100%

90%

80%

70%

60%

50%

40%

30%

20% Percentage of participant group 10%

Br M ea a V th nt is H te ra ua e P ch lis alin ra F n a g ye oc M iqu tio te r u o S e n c s o ve o hn n m un Ot iq D en d he Students (n=1940) ue eit t r y o r Teachers (n=1159) Gu ru Meditation technique

4. Results

As for the previous question, of particular interest were the participants who elected not to or who were unable to answer this question, suggesting that they did not include meditation as part of their practice.

Of students, 1940 of 2497 (78%) participants who submitted this module of the questionnaire answered the question, leaving 22% who may not have included meditation as part of their practice. For teachers, 1159 of 1223 (95%) answered the question.

‘Other’ meditation techniques in order of frequency of mention were:

Vipassana (Buddhist) 25 Trataka 23 Chakra/Kundalini 21 Yoga Nidra 13 Mindfulness 10 Stillness 10 Self-inquiry 7 Zen 5

4. Results

4.2.10. Supervision of practice

Participants were asked to estimate the proportion of their practice they did at home (unsupervised) compared to in a class setting (supervised or under the guidance of a teacher).

Table 4.2.38 and Figure 4.2.39 below show supervision of practice by participant group.

Table 4.2.38. Supervision of practice by participant group

Participant Group Student Teacher Total Places Only at home Count 82 106 188 of % within Participant Group 3.3% 8.8% 5.1% practice Mostly at home (70-90% Count 197 456 653 at home) % within Participant Group 8.0% 38.0% 17.9%

More at home than in Count 234 237 471 class (50-70% at home) % within Participant Group 9.5% 19.8% 12.9% More in class than at Count 374 192 566 home (30-50% at home) % within Participant Group 15.2% 16.0% 15.5% Mostly in a class Count 1040 177 1217 (10-30% at home) % within Participant Group 42.4% 14.8% 33.3% Only in a class Count 527 32 559 % within Participant Group 21.5% 2.7% 15.3% Total Count 2454 1200 3654 % within Participant Group 100.0% 100.0% 100.0%

Figure 4.2.39. Supervision of practice by participant group pp 45%

40%

35%

30%

25%

20%

15%

10% Percentage of participant group of participant Percentage 5%

Only at home Mostly at home More at home than in class More in class than Students (n=2454) at home Mostly in class Teachers (n=1200) Supervision Only in a class

Unsurprisingly, students practised mostly in a class setting, while teachers practised mostly at home or unsupervised.

4. Results

4.2.11. Places of practice

Participants were asked to indicate the locations or venues where they had attended a class in the previous 12 months. Multiple selections were possible.

Table 4.2.40 and Figure 4.2.41 below show places of practice by participant group.

Table 4.2.40. Places of practice by participant group

Participant Group Student Teacher Total Places Dedicated yoga studiuo Count 1614 918 2532 of a % within participant group 66.7% 77.9% practice Ashram or similar Count 179 390 569 % within participant group 7.4% 33.1% At work, in the workplace Count 213 77 290 % within participant group 8.8% 6.5% School, college or Count 104 92 196 university % within participant group 4.3% 7.8% Gym or leisure centre Count 507 216 723 % within participant group 20.9% 18.3% Medical or natural Count 55 41 96 therapies centre % within participant group 2.3% 3.5% Home class Count 315 359 674 % within participant group 13.0% 30.4% Church or community hall Count 503 233 736 % within participant group 20.8% 19.8% Other Count 124 109 233 % within participant group 5.1% 9.2% Total Count 2421 1179 3600 Percentages and totals are based on respondents. a. Dichotomy group tabulated at value 1.

Figure 4.2.41. Places of practice by participantp group

80%

70%

60%

50%

40%

30%

20% Percentage of participant group participant of Percentage 10%

Dedicated Ashram or yoga studio In the similar School, workplace, Gym or college or Medical or corporate leisure university natural In your sponsored centre home or Church hall Students (n=2421) therpaies or Other centre teachers Teachers (n=1179) home community Places centre

4. Results

4.2.12. Reasons for not practising

Participants were asked to indicate the reasons why they either had not practised in the previous 12 months, or why they practised less often than they would like. Multiple selections were possible.

Table 4.2.42 and Figure 4.2.43 below show reasons for not practising by participant group.

Table 4.2.42. Reasons for not practising by participant group

Participant Group Student Teacher Total Reasons Lack of time, family or Count 1001 392 1393 for not a work commitments % within participant group 78.1% 76.7% practising Money, financial Count 275 68 343 circumstances, cost of % within participant group classes 21.5% 13.3%

Motivation, lost interest, Count 158 78 236 moved on % within participant group 12.3% 15.3% Quality, not satisfied with Count 82 36 118 teacher, school or style % within participant group 6.4% 7.0% Availability, no classes in Count 235 82 317 preferred style % within participant group 18.3% 16.0% No particular reason, Count 77 73 150 taking a break % within participant group 6.0% 14.3% Other Count 254 107 361 % within participant group 19.8% 20.9% Total Count 1282 511 1793

Figure 4.2.43. Reasons for not practising by participant group

80%

70%

60%

50%

40%

30%

20% Percentage of respondents

10%

Lack of time, Money, financial family or work Motivation, lost circumstances, Quality, not commitments interest, moved cost of classes satisfied with Availability, no on No particular teacher, school classes in Other preferred style reason, taking a Students (n=1282) or style break Teachers (n=511) Reasons

4. Results

4.2.13. Money spent on practice

Participants were asked how much money they spent per month, on average, on their yoga or meditation practice, including:

Attending classes Purchasing accessories such as books, magazines, DVDs, yoga mats, etc Other (any other spending)

Table 4.2.44 and Figure 4.2.45 below shows the mean amount spent per month in each category by participant group

Table 4.2.44. Money spent on practice per month by participant group

Participant Group Classes Accessories Other Total Student Mean $70.36 $8.63 $4.96 $83.94 N 2379 2379 2379 2379 Std. Deviation 49.371 23.491 40.590 70.239 Teacher Mean $64.88 $28.09 $38.07 $131.04 N 1080 1080 1080 1080 Std. Deviation 72.620 59.527 318.792 360.856 Total Mean $68.65 $14.70 $15.30 $98.65 N 3459 3459 3459 3459 Std. Deviation 57.691 39.579 181.878 210.952

Figure 4.2.45. Money spent on practice per month by participant group

$80

$70

$60

$50

$40 Dollars $30

$20

$10

Classes

Accessories

Students (n=2379) Other Teachers (n=1080) Money spent

The ‘Other’ spending for teachers cannot be taken as reliable in this question. While most teachers reported little or no spending in this category, some reported their spending on attending their teacher training course (an expensive item), thereby artificially inflating the average spending in that category for all teachers.

4. Results

4.2.14. Participant comments

At the end of the practice module in the questionnaire, participants were again given the opportunity to write anecdotal comments. A typical selection of comments is shown in Table 4.2.46 below.

Table 4.2.46.Selected Participant comments to the practice module

29 year old female I started practising yoga because all my friends were. I was going to one lesson a week for that year and walking every other day. Then one day it was raining and I could not walk so I started doing on my own yoga practice at home. Now I attend two yoga classes a week and practice every other day at home. My stress levels are down, I am not competitive anymore, I am a better person; more tolerant and open to alternative options in life and I am a calmer person. My quality of life has improved.

40 year old male I feel that since I have started practising, I am more aware of why I do certain things, and act in a particular way that I didn't fully understand previously. An interesting thing is that I have developed a certain clarity in understanding myself.

47 year old male I have been practising yoga for 20 years and plan to keep doing it for the next 20. I have recently returned to meditation too, helps still my mind.

38 year old female I began with Iyengar yoga, which helped me overcome anorexia, addictions, migraines and RSI. Over the years I have taken a softer but still precise approach and am now drawn to 'deep rest' and am getting extraordinary results for my posture and stamina by taking a calmer approach.

44 year old male LOVE YOGA

49 year old female Meditation helps my mind to settle. I feel that the use of yoga over the years has helped me to recover from my hysterectomy more quickly.

65 year old female I was almost dragged by friends to my first yoga class, and loved it from the first moment. I was then very short of breath and a very heavy smoker, and absolutely battled to breathe through most of the asanas, but persevered when all others dropped out. Today I am a fit, non-breathless non-smoker, and feel fantastic!

49 year old male Yoga has enriched and revitalised every aspect of my life. Now I am hooked I can't do without it.

55 year old female I lead a very busy life and taking the time to focus on my yoga practice helps me to achieve more. Trying to constantly live in the moment improves my concentration.

23 year old female I love yoga. It has changed my life around. It has calmed me and made me a better person. I am just very upset that I had to have an operation on my wrist because I was practising at least 5 days per week. The first time I did a meditation I cried; all my emotions poured out. I am going to be a yoga teacher once I get myself together.

34 year old male The hardest and easiest thing about the postures is letting go.

4. Results

4.3. Health and lifestyle characteristics of respondents

4.3.1. Dietary and lifestyle choices Participants were asked to select the options that best described their current dietary and lifestyle choices and whether they were influenced to make this decision by their yoga practice, as shown in Table 4.3.1. Multiple selections were possible.

Table 4.3.1. Dietary and lifestyle choices by participant group

Student Teacher Total Choice Influenced Choice Influenced Choice Influenced Vegetarian Count 522 169 570 344 1,092 513 % within pt.gp. 22.2% 7.2% 48.8% 29.4% 31.1% 14.6% Vegan Count 40 13 42 21 82 34 % within pt.gp. 1.7% 0.6% 3.6% 1.8% 2.3% 1.0% Prefer organic foods Count 1,151 252 866 373 2,017 625 % within pt.gp. 49.0% 10.7% 74.1% 31.9% 57.4% 17.8% Prefer low sugar, low Count 1,348 156 655 201 2,003 357 GI foods % within pt.gp. 57.4% 6.6% 56.0% 17.2% 57.0% 10.2% Prefer low fat, low Count 1,502 163 637 174 2,139 337 saturated fat foods % within pt.gp. 64.0% 6.9% 54.5% 14.9% 60.8% 9.6% Non-smoker Count 1,960 210 1,027 297 2,987 507 % within pt.gp. 83.5% 8.9% 87.9% 25.4% 85.0% 14.4% Non-drinker Count 558 103 511 239 1,069 342 % within pt.gp. 23.8% 4.4% 43.7% 20.4% 30.4% 9.7% Don't drink caffeine, Count 425 83 311 128 736 211 coffee, tea % within pt.gp. 18.1% 3.5% 26.6% 10.9% 20.9% 6.0% Other Count 340 61 221 91 561 152 % within pt.gp. 14.5% 2.6% 18.9% 7.8% 16.0% 4.3% Total Count 2,347 594 1,169 739 3,516 1,333

Figures 4.3.2 and 4.3.3 below show these choices separately for students and teachers.

A total of 556 respondents described their choices in the ‘Other’ category, most commonly their choice to be vegetarian, eating meat occasionally, eating fish instead, and reducing or eliminating coffee, dairy, wheat, alcohol, and gluten intake. Some also maintained an Ayurvedic diet. Some typical examples include:

I eat only animal products from ethically and ecologically sound sources, ie. grown or made by self, friends or family I’m eating lots of fruit, fresh and dried, raw vegetables and nuts, mainly almonds I am not extreme in any way so I try and reduce red meat, sugar, wheat, alcohol, caffeine, but don't exclude anything completely. I’m a standard meat & vegetable eater. When practising yoga regularly, I tend to opt for less meat dishes.

4. Results

Figure 4.3.2. Dietary and lifestyle choices: Students

90%

80%

70%

60%

50%

40%

30%

Percentage of respondents 20%

10%

Vegetarian Vegan Prefer organic Prefer low foods Prefer low-fat, Non-smoker sugar/low GI Non-drinker low sat. fat Don’t drink foods foods Other Dietary or lifestyle choice (n=2347) caffeine, coffee, tea Influenced by yoga (n=594)

Figure 4.3.3. Dietary and lifestyle choices: Teachers

90%

80%

70%

60%

50%

40%

30%

Percentage of respondents 20%

10%

0% Vegetarian Vegan Prefer organic Prefer low Prefer low-fat, foods Non-smoker sugar/low GI Non-drinker low sat. fat Don’t drink foods foods Other Dietary or lifestyle choice (n=1169) caffeine, coffee, tea Influenced by yoga (n=739)

4. Results

4.3.2. Sporting and physical activity

Participants were asked to select the sports and other physical activities that they had participated in during the previous 12 months by indicating how often they participated.

Any participation in the previous 12 months was compared with data from the ERASS 2006 report. As shown in Table 4.3.4 below, the physical activity of yoga survey participants either equalled the national participation rate (e.g. Soccer and Basketball) or greatly exceeded it. For example, yoga survey students were nearly three times more likely to have walked or run for exercise in the previous 12 months than the national average. Activities where yoga survey participants were more involved than the Australian population are shown with an arrow. Activities which were either not canvassed by ERASS, or not canvassed in the yoga survey, are shown blank.

The final two entries in the table, Pilates and Tai Chi/Body Balance were not reported separately in ERASS; Pilates was included in the yoga figures and it can be assumed that Tai Chi participation is included in the ERASS figure for Martial Arts.

Table 4.3.4. Any sporting and physical activity in the previous 12 months by participant group compared to ERASS

Sport/physical activity ERASS Yoga survey 2006 Student Teacher More likely than ERASS Walking (not bushwalking) 36.2 92.0 91.1 Aerobics 19.1 19.2 13.5 Swimming 13.6 38.3 43.9 Cycling 10.1 31.6 29.8 Running 7.4 23.4 16.0 Tennis 6.8 11.9 10.8 Golf 6.8 9.8 8.5 Bushwalking 4.7 34.5 42.3 Soccer (outdoor) 4.2 4.6 4.0 Netball 3.6 5.8 3.5 Basketball 3.3 3.9 3.2 Cricket (outdoor) 3.2 Weight training 3.1 21.1 14.0 Yoga 2.9 Australian Rules 2.7 3.8 2.6 Touch football 2.4 Dancing 2.4 18.3 24.1 Surf sports 2.3 Fishing 2.1 7.8 5.8 Lawn bowls 2.1 Martial Arts 1.8 5.1 5.7 Squash 1.3 Hockey (outdoor) 1.0 3.8 2.5 Pilates 18.6 13.4 Tai Chi, Body Balance 12.8 10.9

All figures are percentages

4. Results

The same information, comparing the participation in sports and physical activities of students and teachers, is shown in Figure 4.3.5 below.

Figure 4.3.5 Any sporting and physical activity in the previous 12 months by participant group

100

Percentage of participant group Percentage of participant 10

0 Golf Walking Cycling Tennis Aerobics Running Netball Swimming Fishing Dancing Basketball Pilates Bushwalking Aussie Rules Aussie Martial Arts Weight training Soccer (outdoor) Students Teachers

Activity (outdoor) Hockey

Tai Chi, Body Balance

Other activities reported by survey participants (in the ‘Other’ category) and the frequency with which they were mentioned included:

Surfing 59 Gardening 38 Horse riding 25 Rock climbing 24 Skiing 19 Touch football 18 Kayaking 16 Squash 12 Sailing 9 Rowing 9 Volleyball 8

Table 4.3.6 over the next two pages shows all the frequencies of participation in sporting and physical activities by participant group (the table is split over two pages).

The final column in the tables labelled ‘Any’, is the measure of any participation in that activity in the previous 12 months, regardless of frequency, designed to enable comparison with data from the ABS and ERASS.

4. Results

Table 4.3.6. Sporting and physical activities by participant group

5-6 days a 3-4 days a 1-2 days a less than less than Daily week week week weekly monthly None Total Any Walking Student Count 602 342 516 516 191 38 193 2,398 2,205 % within pt. gp. 25.1% 14.3% 21.5% 21.5% 8.0% 1.6% 8.0% 100.0% 92.0% Teacher Count 270 151 248 253 96 27 102 1,147 1,045 % within pt. gp. 23.5% 13.2% 21.6% 22.1% 8.4% 2.4% 8.9% 100.0% 91.1% Total Count 872 493 764 769 287 65 295 3,545 3,250 % within pt. gp. 24.6% 13.9% 21.6% 21.7% 8.1% 1.8% 8.3% 100.0% 91.7% Aerobics Student Count 8 14 74 172 68 125 1,937 2,398 461 % within pt. gp. 0.3% 0.6% 3.1% 7.2% 2.8% 5.2% 80.8% 100.0% 19.2% Teacher Count 2 4 17 39 32 61 992 1,147 155 % within pt. gp. 0.2% 0.3% 1.5% 3.4% 2.8% 5.3% 86.5% 100.0% 13.5% Total Count 10 18 91 211 100 186 2,929 3,545 616 % within pt. gp. 0.3% 0.5% 2.6% 6.0% 2.8% 5.2% 82.6% 100.0% 17.4% Swimming Student Count 10 14 63 256 241 335 1,479 2,398 919 % within pt. gp. 0.4% 0.6% 2.6% 10.7% 10.1% 14.0% 61.7% 100.0% 38.3% Teacher Count 8 10 59 127 134 165 644 1,147 503 % within pt. gp. 0.7% 0.9% 5.1% 11.1% 11.7% 14.4% 56.1% 100.0% 43.9% Total Count 18 24 122 383 375 500 2,123 3,545 1,422 % within pt. gp. 0.5% 0.7% 3.4% 10.8% 10.6% 14.1% 59.9% 100.0% 40.1% Cycling Student Count 48 46 91 187 194 192 1,640 2,398 758 % within pt. gp. 2.0% 1.9% 3.8% 7.8% 8.1% 8.0% 68.4% 100.0% 31.6% Teacher Count 17 17 37 105 77 89 805 1,147 342 % within pt. gp. 1.5% 1.5% 3.2% 9.2% 6.7% 7.8% 70.2% 100.0% 29.8% Total Count 65 63 128 292 271 281 2,445 3,545 1,100 % within pt. gp. 1.8% 1.8% 3.6% 8.2% 7.6% 7.9% 69.0% 100.0% 31.0% Running Student Count 9 30 98 196 112 116 1,837 2,398 561 % within pt. gp. 0.4% 1.3% 4.1% 8.2% 4.7% 4.8% 76.6% 100.0% 23.4% Teacher Count 5 4 24 48 46 56 964 1,147 183 % within pt. gp. 0.4% 0.3% 2.1% 4.2% 4.0% 4.9% 84.0% 100.0% 16.0% Total Count 14 34 122 244 158 172 2,801 3,545 744 % within pt. gp. 0.4% 1.0% 3.4% 6.9% 4.5% 4.9% 79.0% 100.0% 21.0% Tennis Student Count 0 0 4 70 52 159 2,113 2,398 285 % within pt. gp. 0.0% 0.0% 0.2% 2.9% 2.2% 6.6% 88.1% 100.0% 11.9% Teacher Count 1 0 2 20 19 82 1,023 1,147 124 % within pt. gp. 0.1% 0.0% 0.2% 1.7% 1.7% 7.1% 89.2% 100.0% 10.8% Total Count 1 0 6 90 71 241 3,136 3,545 409 % within pt. gp. 0.0% 0.0% 0.2% 2.5% 2.0% 6.8% 88.5% 100.0% 11.5% Golf Student Count 2 0 0 34 32 168 2,162 2,398 236 % within pt. gp. 0.1% 0.0% 0.0% 1.4% 1.3% 7.0% 90.2% 100.0% 9.8% Teacher Count 1 0 0 10 10 77 1,049 1,147 98 % within pt. gp. 0.1% 0.0% 0.0% 0.9% 0.9% 6.7% 91.5% 100.0% 8.5% Total Count 3 0 0 44 42 245 3,211 3,545 334 % within pt. gp. 0.1% 0.0% 0.0% 1.2% 1.2% 6.9% 90.6% 100.0% 9.4% Bushwalking Student Count 8 4 5 44 219 547 1,571 2,398 827 % within pt. gp. 0.3% 0.2% 0.2% 1.8% 9.1% 22.8% 65.5% 100.0% 34.5% Teacher Count 6 3 8 40 155 273 662 1,147 485 % within pt. gp. 0.5% 0.3% 0.7% 3.5% 13.5% 23.8% 57.7% 100.0% 42.3% Total Count 14 7 13 84 374 820 2,233 3,545 1,312 % within pt. gp. 0.4% 0.2% 0.4% 2.4% 10.6% 23.1% 63.0% 100.0% 37.0% Soccer Student Count 0 0 1 18 6 85 2,288 2,398 110 % within pt. gp. 0.0% 0.0% 0.0% 0.8% 0.3% 3.5% 95.4% 100.0% 4.6% Teacher Count 0 0 0 6 5 35 1,101 1,147 46 % within pt. gp. 0.0% 0.0% 0.0% 0.5% 0.4% 3.1% 96.0% 100.0% 4.0% Total Count 0 0 1 24 11 120 3,389 3,545 156 % within pt. gp. 0.0% 0.0% 0.0% 0.7% 0.3% 3.4% 95.6% 100.0% 4.4% Netball Student Count 0 0 2 34 20 84 2,258 2,398 140 % within pt. gp. 0.0% 0.0% 0.1% 1.4% 0.8% 3.5% 94.2% 100.0% 5.8% Teacher Count 0 0 0 8 3 29 1,107 1,147 40 % within pt. gp. 0.0% 0.0% 0.0% 0.7% 0.3% 2.5% 96.5% 100.0% 3.5% Total Count 0 0 2 42 23 113 3,365 3,545 180 % within pt. gp. 0.0% 0.0% 0.1% 1.2% 0.6% 3.2% 94.9% 100.0% 5.1%

4. Results

Table 4.3.6. (continued)

5-6 days a 3-4 days a 1-2 days a less than less than Daily week week week weekly monthly None Total Any Basketball Student Count 1 0 0 8 8 76 2,305 2,398 93 % within pt. gp. 0.0% 0.0% 0.0% 0.3% 0.3% 3.2% 96.1% 100.0% 3.9% Teacher Count 0 0 1 4 3 29 1,110 1,147 37 % within pt. gp. 0.0% 0.0% 0.1% 0.3% 0.3% 2.5% 96.8% 100.0% 3.2% Total Count 1 0 1 12 11 105 3,415 3,545 130 % within pt. gp. 0.0% 0.0% 0.0% 0.3% 0.3% 3.0% 96.3% 100.0% 3.7% Weight training Student Count 10 13 90 236 85 73 1,891 2,398 507 % within pt. gp. 0.4% 0.5% 3.8% 9.8% 3.5% 3.0% 78.9% 100.0% 21.1% Teacher Count 1 1 28 76 20 35 986 1,147 161 % within pt. gp. 0.1% 0.1% 2.4% 6.6% 1.7% 3.1% 86.0% 100.0% 14.0% Total Count 11 14 118 312 105 108 2,877 3,545 668 % within pt. gp. 0.3% 0.4% 3.3% 8.8% 3.0% 3.0% 81.2% 100.0% 18.8% Aussie Rules Student Count 0 0 1 1 7 81 2,308 2,398 90 % within pt. gp. 0.0% 0.0% 0.0% 0.0% 0.3% 3.4% 96.2% 100.0% 3.8% Teacher Count 0 0 0 0 2 28 1,117 1,147 30 % within pt. gp. 0.0% 0.0% 0.0% 0.0% 0.2% 2.4% 97.4% 100.0% 2.6% Total Count 0 0 1 1 9 109 3,425 3,545 120 % within pt. gp. 0.0% 0.0% 0.0% 0.0% 0.3% 3.1% 96.6% 100.0% 3.4% Dancing Student Count 3 3 23 123 108 179 1,959 2,398 439 % within pt. gp. 0.1% 0.1% 1.0% 5.1% 4.5% 7.5% 81.7% 100.0% 18.3% Teacher Count 4 0 7 68 91 106 871 1,147 276 % within pt. gp. 0.3% 0.0% 0.6% 5.9% 7.9% 9.2% 75.9% 100.0% 24.1% Total Count 7 3 30 191 199 285 2,830 3,545 715 % within pt. gp. 0.2% 0.1% 0.8% 5.4% 5.6% 8.0% 79.8% 100.0% 20.2% Fishing Student Count 0 0 0 4 28 154 2,212 2,398 186 % within pt. gp. 0.0% 0.0% 0.0% 0.2% 1.2% 6.4% 92.2% 100.0% 7.8% Teacher Count 0 0 0 3 15 49 1,080 1,147 67 % within pt. gp. 0.0% 0.0% 0.0% 0.3% 1.3% 4.3% 94.2% 100.0% 5.8% Total Count 0 0 0 7 43 203 3,292 3,545 253 % within pt. gp. 0.0% 0.0% 0.0% 0.2% 1.2% 5.7% 92.9% 100.0% 7.1% Tai Chi, Body Bal Student Count 7 2 13 104 56 124 2,092 2,398 306 % within pt. gp. 0.3% 0.1% 0.5% 4.3% 2.3% 5.2% 87.2% 100.0% 12.8% Teacher Count 6 4 16 26 23 50 1,022 1,147 125 % within pt. gp. 0.5% 0.3% 1.4% 2.3% 2.0% 4.4% 89.1% 100.0% 10.9% Total Count 13 6 29 130 79 174 3,114 3,545 431 % within pt. gp. 0.4% 0.2% 0.8% 3.7% 2.2% 4.9% 87.8% 100.0% 12.2% Pilates Student Count 4 4 26 190 88 135 1,951 2,398 447 % within pt. gp. 0.2% 0.2% 1.1% 7.9% 3.7% 5.6% 81.4% 100.0% 18.6% Teacher Count 8 5 14 48 24 55 993 1,147 154 % within pt. gp. 0.7% 0.4% 1.2% 4.2% 2.1% 4.8% 86.6% 100.0% 13.4% Total Count 12 9 40 238 112 190 2,944 3,545 601 % within pt. gp. 0.3% 0.3% 1.1% 6.7% 3.2% 5.4% 83.0% 100.0% 17.0% Martial arts Student Count 1 1 7 20 16 77 2,276 2,398 122 % within pt. gp. 0.0% 0.0% 0.3% 0.8% 0.7% 3.2% 94.9% 100.0% 5.1% Teacher Count 0 1 4 17 10 33 1,082 1,147 65 % within pt. gp. 0.0% 0.1% 0.3% 1.5% 0.9% 2.9% 94.3% 100.0% 5.7% Total Count 1 2 11 37 26 110 3,358 3,545 187 % within pt. gp. 0.0% 0.1% 0.3% 1.0% 0.7% 3.1% 94.7% 100.0% 5.3% Hockey Student Count 1 0 2 7 6 76 2,306 2,398 92 % within pt. gp. 0.0% 0.0% 0.1% 0.3% 0.3% 3.2% 96.2% 100.0% 3.8% Teacher Count 0 0 0 2 2 25 1,118 1,147 29 % within pt. gp. 0.0% 0.0% 0.0% 0.2% 0.2% 2.2% 97.5% 100.0% 2.5% Total Count 1 0 2 9 8 101 3,424 3,545 121 % within pt. gp. 0.0% 0.0% 0.1% 0.3% 0.2% 2.8% 96.6% 100.0% 3.4% Other 1 Student Count 20 10 46 144 38 47 2,093 2,398 305 % within pt. gp. 0.8% 0.4% 1.9% 6.0% 1.6% 2.0% 87.3% 100.0% 12.7% Teacher Count 21 10 20 40 17 34 1,005 1,147 142 % within pt. gp. 1.8% 0.9% 1.7% 3.5% 1.5% 3.0% 87.6% 100.0% 12.4% Total Count 41 20 66 184 55 81 3,098 3,545 447 % within pt. gp. 1.2% 0.6% 1.9% 5.2% 1.6% 2.3% 87.4% 100.0% 12.6%

4. Results

Figures 4.3.7 and 4.3.8 below graphically represent the information in the tables on the previous two pages for the seven most popular activities amongst yoga survey participants.

Walking is the dark blue series at the back of each graph, illustrating that both students and teachers were most likely to walk, either daily, 3-4, or 1-2 days a week.

Figure 4.3.7. Frequency of practice in the most popular sporting and physical activities: Students

30%

25%

20%

15% Walking

10% Swimming

5% Bushwalking

Percentage of respondents 0% Cycling

Daily Running 5-6 days a week 3-4 days a Weight training week 1-2 days a Aerobics Weight training week Aerobics Running Cycling less than weekly Bushwalking Swimming less than Walking monthly

Figure 4.3.8. Frequency of practice in the most popular sporting and physical activities: Teachers

25%

20%

15%

Walking 10% Swimming

5% Bushwalking

Percentage of respondents 0% Cycling

Daily Running 5-6 days a week 3-4 days a Weight training week 1-2 days a Aerobics Weight training week Aerobics Running Cycling less than weekly Bushwalking Swimming less than Walking monthly

4. Results

4.3.3. Heath issues and medical conditions

4.3.3.1. Introduction Participants were asked to think of any health issues or medical conditions for which they had used yoga as part of the management or treatment of the condition.

Conditions were grouped as follows and examples given:

Gastrointestinal e.g. irritable bowel syndrome, coeliac disease Musculoskeletal e.g. back or neck pain, muscular pain, arthritis Respiratory e.g. asthma, lung or respiratory problems Cardiovascular e.g. heart disease, high blood pressure Mental health e.g. anxiety, depression, sleep difficulties Womens’ health e.g. pregnancy, postnatal, menopause Other e.g. stress, weight management, diabetes

A seven point rating scale was provided, explained as follows:

1. Much better e.g. condition improved, symptoms improved 2. Better e.g. condition improved, symptoms the same 3. Little better e.g. condition the same, symptoms improved 4. Same e.g. condition the same, symptoms the same 5. Little worse e.g. condition the same, symptoms worse 6. Worse e.g. condition worse, symptoms the same 7. Much worse e.g. condition worse, symptoms worse

Participants were asked to write a brief description of the condition under the appropriate category, as shown above, and then to rate the perceived effect of their practice on the condition. Multiple selections were possible. The actual question is shown in Figure 4.3.9 over the page.

Of the 2437 students and 1179 teachers who submitted the health module in the questionnaire, 1862 students (76.4%) and 959 teachers (81.34%) completed this question about health issues and medical conditions.

Note: The groupings of conditions above were informed by the conditions for which yoga or meditation-related interventions were found in the earlier literature review. It is acknowledged that this question represented a somewhat simplistic measure of perceived benefit, however it would likely inform and provide a basis for more detailed research into the perceived benefits of yoga practice for a range of conditions in the future.

4. Results

Figure 4.3.9. Screenshot of the health issues and medical conditions question

4. Results

4.3.3.2. Health issues and medical conditions reported The number and proportion of conditions reported by all respondents in each category are shown in Table 4.3.10 below (2821 respondents, 7551 conditions)

Table 4.3.10. Conditions reported by all respondents in each category

Percentage of category Gastrointestinal (n=539, 7.1% of conditions) Irritable bowel syndrome 45.81% Constipation 13.47% Poor digestion, bloating 11.98% Indigestion, reflux 5.99% Coeliac disease 3.89%

Musculoskeletal (n=2073, 27.5% of conditions) Back pain/problems 52.48% Neck pain/problems 29.62% Shoulder pain/problems 10.38% Muscular pain/problems 8.65% Joint pain/problems 7.37% Arthritis 6.84% Sciatica 2.41% Scoliosis 3.16% Disc injuries 2.56% Sacroiliac joint 0.60% Fibromyalgia 0.60% Osteoporosis 0.60%

Respiratory (n=539, 7.1% of conditions) Asthma 43.29% Hay fever, sinusitis, allergies 11.41% Colds and flu 8.72% Quit smoking 7.72% Bronchitis 5.03% Shallow breathing 3.02%

Cardiovascular (n=290, 3.8% of conditions) High or low blood pressure (80% high) 66.23% Metabolic, insulin resistance synd, diabetes 7.79% Palpitations, tachycardia 4.55% To improve circulation 3.90% High cholesterol 2.60%

Continued over

4. Results

Table 4.3.10. (continued)

Percentage of category Mental health (n=1797, 23.8% of conditions) (composite inc. stress, n=2694, 35.7% of conditions) Anxiety 43.59% Depression 31.63% Sleep difficulties, insomnia 23.63% Stress (also reported in category below) 13.40% Headaches, migraine 11.67% Mood disorders, bipolar 2.22% Panic attacks 1.16%

Womens health (n=781, 10.3% of conditions) Menopause symptoms, hot flushes 30.00% Pregnancy and post natal 32.83% Polycystic ovary syndrome 1.89% Pre menstrual syndrome, hormonal imbalance 28.11% Endometriosis 2.26%

Stress, weight management (n=1212, 16.0% of conditions) Stress (also reported in category above) 73.99% Weight management 26.94%

Other (n=320, 4.2% of conditions) Muscle tone and flexibility 15.29% Cancer and chemotherapy 11.76% Enhance health and well-being 5.88% Fatigue, chronic fatigue, glandular fever 5.59% Thyroid disease 4.41% Enhance immune system 2.65% Skin conditions, psoriasis, eczema 2.65% Improve posture 2.35% Surgery post-op 2.35% Drug and alcohol addiction 1.76% Epilepsy 1.18% Multiple sclerosis 0.88%

4. Results

Of interest was that yoga survey participants reported that they used yoga more for stress management than for the traditional ‘bad back’. Stress management was reported by participants in both the Mental health category and the Stress management category, resulting in a composite total of 1137 participants citing ‘to reduce stress’, compared to 1088 participants who listed back pain or other back problems. Combining stress management with the mental health category resulted in a composite total of 2694 mental health conditions (35.7% of all the conditions reported), compared to 2073 musculoskeletal conditions (27.5% of conditions).

Women's health was the next largest area (10.3% of conditions) with reported improvement in menstrual/menopausal symptoms and assistance during and after pregnancy; ahead of gastrointestinal (7.1%), respiratory (7.1%), and cardiovascular (3.8%), with consistent improvement across all categories. Amongst students, 95.1% of conditions were reported as improved by yoga practice, with another 4.5% unchanged. Amongst teachers, those figures were 97.8% and 1.9% respectively.

4. Results

4.3.3.3. Perceived effect of yoga practice on medical conditions Figures 4.3.11 and 4.3.12 below represent the perceived effect of yoga practice on the conditions in each category for students and for teachers (in separate graphs).

Figure 4.3.11. Perceived effect of yoga practice on medical conditions: Students (N=1862)

70%

60%

50%

40%

30% Other (n=201) Stress, weight (n=850) 20% Womens health (n=419)

Percentage of respondents of Percentage Mental health (n=1144) 10% Cardiovascular (n=174) 0% Respiratory (n=305) Much Musculoskeletal (n=1339) Better better Little better Same Gastrointestinal (n=322) Little worse Worse Much Perceived change worse

Figure 4.3.12. Perceived effect of yoga practice on medical conditions: Teachers (N=959)

80%

70%

60%

50%

40% Other (n=119) 30% Stress, weight (n=362) 20% Womens health (n=362)

Percentage of respondents Mental health (n=653) 10% Cardiovascular (n=116) 0% Respiratory (n=234) Much Musculoskeletal (n=734) Better better Little better Same Gastrointestinal (n=217) Little worse Worse Much Perceived change worse

4. Results

Table 4.3.13 below presents the data for the graphs on the preceding page.

Table 4.3.13. Perceived effect of yoga practice on medical conditions by participant group

Students n=1862 Much Little Little Much % of Teachers n=959 better Better better Same worse Worse worse Total Total Gastrointestinal Student Count 132 89 59 42 0 0 0 322 6.8% % within pt. gp. 41.0% 27.6% 18.3% 13.0% 0.0% 0.0% 0.0% 100.0% Teacher Count 134 47 27 6 1 2 0 217 7.8% % within pt. gp. 61.8% 21.7% 12.4% 2.8% 0.5% 0.9% 0.0% 100.0% Total Count 266 136 86 48 1 2 0 539 7.1% % within pt. gp. 49.4% 25.2% 16.0% 8.9% 0.2% 0.4% 0.0% 100.0% Musculoskeletal Student Count 807 348 148 27 6 1 2 1,339 28.2% % within pt. gp. 60.3% 26.0% 11.1% 2.0% 0.4% 0.1% 0.1% 100.0% Teacher Count 554 134 37 6 1 1 1 734 26.2% % within pt. gp. 75.5% 18.3% 5.0% 0.8% 0.1% 0.1% 0.1% 100.0% Total Count 1,361 482 185 33 7 2 3 2,073 27.5% % within pt. gp. 65.7% 23.3% 8.9% 1.6% 0.3% 0.1% 0.1% 100.0% Respiratory Student Count 1359650240 003056.4% % within pt. gp. 44.3% 31.5% 16.4% 7.9% 0.0% 0.0% 0.0% 100.0% Teacher Count 162 51 16 5 0 0 0 234 8.4% % within pt. gp. 69.2% 21.8% 6.8% 2.1% 0.0% 0.0% 0.0% 100.0% Total Count 297 147 66 29 0 0 0 539 7.1% % within pt. gp. 55.1% 27.3% 12.2% 5.4% 0.0% 0.0% 0.0% 100.0% Cardiovascular Student Count 61 48 35 28 2 0 0 174 3.7% % within pt. gp. 35.1% 27.6% 20.1% 16.1% 1.1% 0.0% 0.0% 100.0% Teacher Count 75 19 13 9 0 0 0 116 4.1% % within pt. gp. 64.7% 16.4% 11.2% 7.8% 0.0% 0.0% 0.0% 100.0% Total Count 1366748372 002903.8% % within pt. gp. 46.9% 23.1% 16.6% 12.8% 0.7% 0.0% 0.0% 100.0% Mental health Student Count 620 369 127 27 1 0 0 1,144 24.1% % within pt. gp. 54.2% 32.3% 11.1% 2.4% 0.1% 0.0% 0.0% 100.0% Teacher Count 491 125 34 2 0 0 1 653 23.3% % within pt. gp. 75.2% 19.1% 5.2% 0.3% 0.0% 0.0% 0.2% 100.0% Total Count 1,111 494 161 29 1 0 1 1,797 23.8% % within pt. gp. 61.8% 27.5% 9.0% 1.6% 0.1% 0.0% 0.1% 100.0% Womens health Student Count 196 138 54 27 1 1 2 419 8.8% % within pt. gp. 46.8% 32.9% 12.9% 6.4% 0.2% 0.2% 0.5% 100.0% Teacher Count 2376738181 1036212.9% % within pt. gp. 65.5% 18.5% 10.5% 5.0% 0.3% 0.3% 0.0% 100.0% Total Count 433 205 92 45 2 2 2 781 10.3% % within pt. gp. 55.4% 26.2% 11.8% 5.8% 0.3% 0.3% 0.3% 100.0% Stress, weight Student Count 456 265 102 26 1 0 0 850 17.9% % within pt. gp. 53.6% 31.2% 12.0% 3.1% 0.1% 0.0% 0.0% 100.0% Teacher Count 264 75 18 5 0 0 0 362 12.9% % within pt. gp. 72.9% 20.7% 5.0% 1.4% 0.0% 0.0% 0.0% 100.0% Total Count 720 340 120 31 1 0 0 1,212 16.1% % within pt. gp. 59.4% 28.1% 9.9% 2.6% 0.1% 0.0% 0.0% 100.0% Other Student Count 1294019112 002014.2% % within pt. gp. 64.2% 19.9% 9.5% 5.5% 1.0% 0.0% 0.0% 100.0% Teacher Count 91 18 7 3 0 0 0 119 4.3% % within pt. gp. 76.5% 15.1% 5.9% 2.5% 0.0% 0.0% 0.0% 100.0% Total Count 2205826142 003204.2% % within pt. gp. 68.8% 18.1% 8.1% 4.4% 0.6% 0.0% 0.0% 100.0% Total Student Count 2,536 1,393 594 212 13 2 4 4,754 % within pt. gp. 53.3% 29.3% 12.5% 4.5% 0.3% 0.0% 0.1% 100.0% Teacher Count 2,008 536 190 54 3 4 2 2,797 % within pt. gp. 71.8% 19.2% 6.8% 1.9% 0.1% 0.1% 0.1% 100.0% Total Count 4,544 1,929 784 266 16 6 6 7,551 % within pt. gp. 60.2% 25.5% 10.4% 3.5% 0.2% 0.1% 0.1% 100.0%

4. Results

4.3.3.4. Medical conditions summary

The 1862 students who answered this question reported a total of 4754 conditions for which they used yoga. They were perceived as:

Much better 53.3% Better 29.3% Little better 12.5% No Change 4.5% Little worse 0.3% (13) Worse 0.0% (2) Much worse 0.4% (4)

The 959 teachers reported a total of 2797 health conditions. They were perceived as:

Much better 71.8% Better 19.2% Little better 6.8% No Change 1.9% Little worse 0.1% (3) Worse 0.1% (4) Much worse 0.1% (2)

The total of 28 conditions reported by students and teachers to have worsened are shown in Table 4.3.14 over the page along with the details provided by the participant.

4. Results

Table 4.3.14. All conditions reported to have got worse from yoga practice

Teacher/ Student Age Gender Perceived effect Details provided Gastrointestinal Re-section of small and T 47 F Little worse large intestine T 36 F Worse blood pressure T 29 F Worse IBS Musculoskeletal T 33 F Worse sciatica pains S 54 F Little worse hip, neck/shoulder S 33 F Much worse Lupus S 32 F Little worse lower back S 45 F Much worse lower back pain S 45 F Little worse S 31 M Little worse joint pain T 24 F Little worse T 48 F Much worse inflamed joints S 34 F Little worse back pain S 59 F Little worse arthritis in knee S 58 M Worse Cardiovascular S 66 F Little worse high blood pressure S 37 F Little worse Mental health T 31 F Much worse S 37 F Little worse Women’s health S 48 F Much worse pregnancy S 23 F Little worse T 24 F Worse amennorrhoea S 36 M Worse T 31 F Little worse S 30 F Much worse pregnancy Other S 45 F Little worse stress S 42 F Little worse Low blood pressure toning abdomen after S 45 F Little worse operation

4. Results

4.3.4. Perceptions of quality of life

4.3.4.1. Introduction Participants were asked to indicate how their practice of yoga had influenced their perceptions of quality of life in five areas.

Areas were grouped and examples were provided as follows:

Physical health e.g. fitness, muscle tone, flexibility, energy levels Mental health e.g. memory, depression, sense of purpose, positivity Emotional health e.g. emotional stability, anger, stress or anxiety levels Spiritual health e.g. relationship with higher power, sense of inner- peace and happiness Relationships e.g. quality of close relationships, friends, family life, sex-life

Once again, a seven point rating scale was used:

1. Much better 2. Better 3. Little better 4. Same 5. Little worse 6. Worse 7. Much worse

Participants were asked to write a brief description under the appropriate category and then to rate the perceived effect of their practice on that aspect of their life.

Of the 2437 students and 1179 teachers who completed this module in the questionnaire, 2389 students (98.03%) and 1162 teachers (98.56%) completed this question about their perceptions of quality of life.

4.3.4.2. Perceived effect of yoga practice on quality of life Perceptions of quality of life appeared to be dramatically improved in all areas; however, this was less consistent in the area of close relationships. Of those who said their quality of life worsened (33), most were in the area of relationships (25).

Some typical participant comments to this question were:

My ex husband didn't share the experience It gets harder being close to friends who are not 'into it' My spiritual development was one of the main contributing factors in my divorce It can be alienating at times as most people eat meat, etc Partner not keeping pace!

4. Results

Figures 4.3.15 and 4.3.16 below show the perceptions of quality of life in each category for students and teachers (in separate graphs).

Figure 4.3.15. Perceptions of quality of life: Students (N=2389)

60%

50%

40%

30%

20% Percentage of respondents 10% Relationships (n=1828) Spiritual health (n=1919) 0% Emotional health (n=2180) Much better Mental health (n=2098) Better Little better Same Physical health (n=2361) Little worse Worse Much worse Perceived change

Figure 4.3.16. Perceptions of quality of life: Teachers (N=1162)

80%

70%

60%

50%

40%

30%

20% Percentage of respondents Percentage

10% Relationships (n=1061) Spiritual health (n=1117) 0% Emotional health (n=1120) Much better Mental health (n=1104) Better Little better Same Physical health (n=1144) Little worse Worse Much worse Perceived change

As for the medical conditions in Section 4.3.3, teachers reported much greater perceived improvement than students in all areas.

4. Results

Table 4.3.17 below presents the data for the graphs on the preceding page.

Table 4.3.17. Perceptions of quality of life by participant group

Students n=2347 Much Little Little Much % of Teachers n=1179 better Better better Same worse Worse worse Total Total Physical Student Count 1345 811 181 23 1 0 0 2,361 49.7% health % within pt. gp. 57.0% 34.3% 7.7% 1.0% 0.0% 0.0% 0.0% 100.0% Teacher Count 875 236 19 14 0 0 0 1,144 40.9% % within pt. gp. 76.5% 20.6% 1.7% 1.2% 0.0% 0.0% 0.0% 100.0% Total Count 2,220 1,047 200 37 1 0 0 3,505 46.4% % within pt. gp. 63.3% 29.9% 5.7% 1.1% 0.0% 0.0% 0.0% 100.0% Mental Student Count 844 852 278 123 1 0 0 2,098 44.1% health % within pt. gp. 40.2% 40.6% 13.3% 5.9% 0.0% 0.0% 0.0% 100.0% Teacher Count 764 279 43 17 1 0 0 1,104 39.5% % within pt. gp. 69.2% 25.3% 3.9% 1.5% 0.1% 0.0% 0.0% 100.0% Total Count 1,608 1,131 321 140 2 0 0 3,202 42.4% % within pt. gp. 50.2% 35.3% 10.0% 4.4% 0.1% 0.0% 0.0% 100.0% Emotional Student Count 902 870 305 103 0 0 0 2,180 45.9% health % within pt. gp. 41.4% 39.9% 14.0% 4.7% 0.0% 0.0% 0.0% 100.0% Teacher Count 753 301 46 17 3 0 0 1,120 40.0% % within pt. gp. 67.2% 26.9% 4.1% 1.5% 0.3% 0.0% 0.0% 100.0% Total Count 1,655 1,171 351 120 3 0 0 3,300 43.7% % within pt. gp. 50.2% 35.5% 10.6% 3.6% 0.1% 0.0% 0.0% 100.0% Spiritual Student Count 750 639 272 258 0 0 0 1,919 40.4% health % within pt. gp. 39.1% 33.3% 14.2% 13.4% 0.0% 0.0% 0.0% 100.0% Teacher Count 815 228 47 25 0 1 1 1,117 39.9% % within pt. gp. 73.0% 20.4% 4.2% 2.2% 0.0% 0.1% 0.1% 100.0% Total Count 1,565 867 319 283 0 1 1 3,036 40.2% % within pt. gp. 51.5% 28.6% 10.5% 9.3% 0.0% 0.0% 0.0% 100.0% Relation Student Count 458 614 291 453 7 4 1 1,828 38.5% -ships % within pt. gp. 25.1% 33.6% 15.9% 24.8% 0.4% 0.2% 0.1% 100.0% Teacher Count 555 329 85 79 5 4 4 1,061 37.9% % within pt. gp. 52.3% 31.0% 8.0% 7.4% 0.5% 0.4% 0.4% 100.0% Total Count 1,013 943 376 532 12 8 5 2,889 38.3% % within pt. gp. 35.1% 32.6% 13.0% 18.4% 0.4% 0.3% 0.2% 100.0% Total Student Count 4,299 3,786 1,327 960 9 4 1 10,386 % within pt. gp. 41.4% 36.5% 12.8% 9.2% 0.1% 0.0% 0.0% 100.0% Teacher Count 3,762 1,373 240 152 9 5 5 5,546 % within pt. gp. 67.8% 24.8% 4.3% 2.7% 0.2% 0.1% 0.1% 100.0% Total Count 8,061 5,159 1,567 1,112 18 9 6 15,932 % within pt. gp. 50.6% 32.4% 9.8% 7.0% 0.1% 0.1% 0.0% 100.0%

4. Results

4.3.5. Participant comments

At the end of the health module in the questionnaire, participants were given the opportunity to write comments. A typical selection of comments is shown in Table 4.3.18 below.

Table 4.3.18. Participant comments to the health module

36 year old female Yoga helps me to gain fitness, strength and to lose weight. I have Multiple Sclerosis and chronic back pain, shoulder and neck pain and intermittent migraines. Plus it gives me a positive purpose for leaving the house and meeting new people.

31 year old female Yoga is the most wonderful stress reliever and mood moderator I know. My kids and husband are so glad I do yoga every day, as it makes their world a better place. I am happy and emotionally available purely because of yoga.

31 year old female I suffer from Juvenile Rheumatoid Arthritis, and yoga has probably been the most effective treatment for me in terms of gaining mobility. I wish it had been recommended to me 15 years ago when I was first diagnosed, it would have meant a more mobile and flexible me now! I think yoga should be encouraged in schools.

52 year old male I have had bi-polar depression and anxiety for over 30 years. Yoga and meditation have greatly benefited both. In my experience, this is greatly underestimated by healthcare workers and ignored by psychiatrists.

32 year old female Yoga has helped me manage chronic back pain. Nothing else I have tried has worked as well as yoga. If I miss a class, I can really feel it. It is now part of my life, and I don’t know where I would be without it.

53 year old female On coming out of hospital having had a cancerous lump removed from my breast, a friend introduced me to Yoga Nidra. I practised daily and the effects were quite remarkable. I moved on to more varied practises and believe yoga has been a very important aspect to my recovery.

62 year old female My GP is an advocate of drug-free stress control. During a very difficult period in my life he reluctantly agreed to give me a prescription of diazepam (Valium) if I would go to Yoga. I kept my word. I didn't finish the prescription.

51 year old female I realised that through my yoga I was able to cope better with the emotional ups and downs of menopause. The yoga practice has made me much more aware of my body's needs and with that knowledge, I could use stretching and flexibility to improve bone density and reduce sciatic pain.

52 year old female For cancer recovery, stress and sleep problems I found a combination of postures, meditation and breathing beneficial.

38 year old female My husband always encourages me to do my practice, even if I don't feel like it because he says it calms me down and relaxes me.

4. Results

4.4. Yoga-related injuries

4.4.1. Introduction Participants were asked to think of any injuries they ever had that may have been attributable to their yoga practice. They were then asked to complete a separate report for each injury, as shown in Figure 4.4.1 below. It was possible to report up to five separate injuries.

Figure 4.4.1. Injury report form

4. Results

A total of 3414 participants, including 2353 students and 1061 teachers completed this module. Of these, 2525 participants, including 1851 students (78.7%) and 674 teachers (63.5%) said they had never been injured practising yoga.

That left 889 participants, including 502 students (21.3%) and 387 teachers (36.5%) who reported 1056 injuries, meaning that 167 participants reported two or more injuries. These ‘injuries’ included:

Many minor, non-specific and self-correcting injuries (e.g. aches and pains, muscle strains) Recurring injuries, and aggravations of pre-existing conditions Injuries sustained more than 12 months ago Injuries that occurred at home or otherwise in unsupervised practice Pre-existing injuries that participants were using yoga to ‘work through’ Injuries that may not have been attributable to yoga, but were first noticed during yoga practice.

4.4.2. Characteristics of participants who reported injuries A summary of the characteristics of respondents is shown in Table 4.4.2 below.

Table 4.4.2. Characteristics of participants who reported injuries by participant group

Student Teacher Number Percentage Number Percentage Completed injury module 2353 91.7% 1061 83.9% Never injured 1851 78.7% 674 63.5% Reported 1 or more injuries 502 21.3% 387 36.5% Reported 2 or more injuries 60 11.9% 71 18.3% Number of injuries reported 576 480 Male 96 19.1% 76 19.6% Female 406 80.9% 311 80.4% Pregnant 16 3.9% 17 5.5% Left-handed 58 11.5% 45 11.6% Age group: Missing data 1 0.0% 0 0.0% 15-24 20 4.0% 2 0.5% 25-34 131 26.1% 95 24.5% 35-44 159 31.7% 129 33.3% 45-54 133 26.5% 114 29.5% 55-64 50 10.0% 40 10.3% 65-74 7 1.4% 6 1.6% 75-84 0 0.0% 1 0.3% 85+ 1 0.0% 0 0.0%

4. Results

4.4.3. Frequency of all postures reported

The 1056 injury reports were individually assessed and responses coded into common themes and groupings of words and phrases. Where specific postures (e.g. Paschimottanasana) or general practices (e.g. forward bends) were mentioned, they were categorised to enable comparison of the frequency of postures involved in injury reports, as shown in Table 4.4.3 and Figure 4.4.4 below.

Table 4.4.3. Frequency of all postures reported

Description Frequency Percentage of reports Headstand, Sirsanana 78 7.4% Shoulder stands, Sarvangasana 67 6.3% Lotus, Padmasana, half lotus 56 5.3% Forward bends 51 4.8% Back bends 33 3.1% Hand stands 26 2.5% Trikonasana, inc Parvritta (2) 25 2.4% Standing, seated and supine twists 24 2.3% Salute to the sun, Surya Namaskar 20 1.9% Downward dog 16 1.5% Konasana, (Baddha 7) (Upavista 6) 13 1.2% Paschimottanasana 9 0.9% Kurmasana (Supta 4) 8 0.8% Chakrasana 7 0.7% Dhanurasana (Urdhva 4) 7 0.7% Halasana 7 0.7% Cobra, Bhujangasana 7 0.7% Plough 7 0.7% Bridge 6 0.6% Marichyasana D 6 0.6% Camel, Ustrasana 5 0.5% Warrior, Virabhadrasana variations 5 0.5% Dog or cat pose 5 0.5% Plank 4 0.4% Rolling backwards and forwards 4 0.4% Vajrasana 4 0.4% Eka Pada Sirsasana, Yoga Nidrasana 4 0.4% Tree Posture 3 0.3% Upward dog 3 0.3% Sitting cross legged 3 0.3% All others, and those in which no specific posture or practice 543 was mentioned Total 1056

4. Results

Figure 4.4.4. Frequency of all postures reported

Frequency 30

0 Cobra Bridge Plough Camel Headstands Back bends Plank Handstands Halasana Rolling Trikonasana Chakrasana Forward bends Lotus, half lotus Shoulder stands Downward dog Vajrasana Twists variations Salute to the sun Upward dog Tree posture Marichyasana D Dog or cat pose Paschimottanasana Konasana variations Warrior variations Kurmasana variations Leg/s behind head Dhanurasana variations

4.4.4. Other contributing factors reported

Participants commonly took the blame for the injury on themselves, citing reasons such as:

Pushed myself too hard 65 Over-stretched 60 Not warming up properly 45 Ego driven 29 It was my fault 28

However some participants also cited:

Insufficient instruction or supervision from teacher Lack of knowledge or understanding of correct technique Attempting advanced postures before being ready The effect of peer pressure in class; ‘everyone else was doing it’ Teachers pushing students to attempt posture or ‘work through’ the pain Adjustment by teacher too forceful or inappropriate for student’s needs

Teachers themselves commonly reported repetitive strain and over-use injuries, also sometimes injuries sustained or aggravated as a result of participating in ‘intensive’ or prolonged training sessions, sometimes over many months.

4. Results

4.4.5. Parts of the body affected

Participants were asked to identify all the parts of the body affected by the injury they were reporting. Multiple selections were possible, as shown in Table 4.4.5 and Figure 4.4.6 below. Responses were also manually coded to create additional specific categories for wrist, elbow, knee, ankle and hamstring/groin injuries from the written information provided.

Table 4.4.5. Parts of the body affected by participant group

Participant Group Student Teacher Total Part of Head Count 16 15 31 the % within Part of the body 51.6% 48.4% body a % within Participant Group 2.9% 3.2% affected Neck Count 146 104 250 % within Part of the body 58.4% 41.6% % within Participant Group 26.1% 22.5% Shoulder Count 130 94 224 % within Part of the body 58.0% 42.0% % within Participant Group 23.3% 20.3% Back Count 162 158 320 % within Part of the body 50.6% 49.4% % within Participant Group 29.0% 34.2% Arm Count 28 22 50 % within Part of the body 56.0% 44.0% % within Participant Group 5.0% 4.8% Hip Count 54 58 112 % within Part of the body 48.2% 51.8% % within Participant Group 9.7% 12.6% Leg Count 48 39 87 % within Part of the body 55.2% 44.8% % within Participant Group 8.6% 8.4% Foot Count 28 13 41 % within Part of the body 68.3% 31.7% % within Participant Group 5.0% 2.8% Wrist Count 26 14 40 % within Part of the body 65.0% 35.0% % within Participant Group 4.7% 3.0% Elbow Count 4 8 12 % within Part of the body 33.3% 66.7% % within Participant Group .7% 1.7% Knee Count 89 94 183 % within Part of the body 48.6% 51.4% % within Participant Group 15.9% 20.3% Ankle Count 8 3 11 % within Part of the body 72.7% 27.3% % within Participant Group 1.4% .6% Hamstring, groin Count 40 56 96 % within Part of the body 41.7% 58.3% % within Participant Group 7.2% 12.1% Internal organ Count 2 11 13 % within Part of the body 15.4% 84.6% % within Participant Group .4% 2.4% Internal system Count 3 9 12 % within Part of the body 25.0% 75.0% % within Participant Group .5% 1.9% Mental Count 21 21 42 % within Part of the body 50.0% 50.0% % within Participant Group 3.8% 4.5% Total Count 559 462 1021

4. Results

Figure 4.4.6. Parts of the body affected by participant group

35%

30%

25%

20%

15%

10% Percentage of injury reports

0% Head Neck Hip Elbow Wrist Back Knee Shoulder Foot Ankle Arm (other)

Students (n=577) Mental Leg (other) Teachers (n=482) Hamstring, groin Internal organ Internal system

The categories shown as ‘Arm (other)’, and ‘Leg (other)’, represent parts of the arm or leg not already reported in another category such as elbow, hamstring or knee.

Back injuries were most prevalent, followed by neck and shoulder, and knee. Interestingly, teachers were over-represented in back, knee and hamstring injuries, perhaps as a result of overuse; while students were over-represented in neck, shoulder and foot injuries.

4. Results

4.4.6. Circumstances surrounding the injury

Participants were asked to identify the circumstances in which the injury happened. Multiple selections were possible, as shown in Table 4.4.7 and Figure 4.4.8 below.

These options were provided in the question to determine the severity and circumstances of injuries, while still allowing participants to report any and all injuries.

Table 4.4.7. Circumstances surrounding the injury by participant group

Participant Group Student Teacher Total Circumstances This was a new injury Count 394 348 742 surroundinga the % within circumstance 53.1% 46.9% injury % within Participant Group 68.4% 72.5% At home or unsupervised Count 152 191 343 % within circumstance 44.3% 55.7% % within Participant Group 26.4% 39.8% Under supervision Count 424 289 713 % within circumstance 59.5% 40.5% % within Participant Group 73.6% 60.2% Received adjustment Count 57 71 128 from teacher % within circumstance 44.5% 55.5% % within Participant Group 9.9% 14.8% Required medical Count 171 167 338 treatment % within circumstance 50.6% 49.4% % within Participant Group 29.7% 34.8% Prolonged pain or Count 194 224 418 discomfort % within circumstance 46.4% 53.6% % within Participant Group 33.7% 46.7% Time off work or financial Count 33 48 81 loss % within circumstance 40.7% 59.3% % within Participant Group 5.7% 10.0% Happened in the last 12 Count 291 123 414 months % within circumstance 70.3% 29.7% % within Participant Group 50.5% 25.6% Total Count 576 480 1056

4. Results

Figure 4.4.8. Circumstances surrounding the injury by participant group

80%

70%

60%

50%

40%

30%

Percentage of injury reports 20%

10%

This was aHappened in new injury At home or the last 12 Under Received unsupervised Required months supervision (in adjustment Prolonged medical Time off work class) from teacher pain or treatment or financial Students (n=576) discomfort loss Teachers (n=480)

4. Results

4.4.7. Style of yoga practised at the time of the injury

Participants were asked what style of yoga they were practising at the time the injury happened. Responses were manually allocated to the same style groups used earlier in this report, as shown in Table 4.4.9 below.

Table 4.4.9. Styles by style group

1. Meditation Styles of yoga focusing on meditation, including Siddha, Sahaja, Raja (e.g. Brahma Kumaris), Turiya, Bhakti, Dharma, Samata, TM, Tantra, and people who only practised pranayama 2. General People who called their style ‘classical’, ‘contemporary’, ‘contemporary classical’, ‘eclectic’, Gita, Yoga in Daily Life, Dru, Ryoho, Oki Do, Kundalini, Integral, IYTA, Ayur and others 3. Satyananda People who described their style as Satyananda 4. Hatha People who only described their style as ‘Hatha’ 5. Iyengar People who described their style as Iyengar 6. Dynamic Stronger, more dynamic styles of yoga, including Ashtanga, Vinyasa Flow, Bikram, Synergy, Power and others 7. Others Styles not able to be categorised due to a lack of information 8. Hybrid Including Yoga Chi Gung, Pilates, Yogalates and Body Balance Note: Contemporary Classical: Respondents who described their style of yoga as ‘contemporary’, ‘classical’, ‘contemporary classical’ or ‘eclectic’. Vinyasa, Flow: Respondents who described their style of yoga as ‘vinyasa’ or ‘flow’ or ‘vinyasa flow’.

Table 4.4.10 below shows the proportion of injury reports by proportion of survey respondents, by style group and participant group. This comparison includes all injuries, whether minor, non-specific or self-correcting, whether recurrences or aggravations of pre- existing conditions, whether they occurred in years past, and whether under supervision at the time or not.

To explain, in order to assess whether a particular style group was over-represented or under-represented in the injury reports, it is necessary to compare the proportion of injury reports for each style group to the proportion of survey respondents for each style group.

Table 4.4.10. Proportion of injury reports by proportion of survey respondents by style group and participant group

Proportion of survey Proportion of injury reports Proportion of representation of respondents style group in injury reports Description Students Teachers Total Students Teachers Total Students Teachers Total (n=2426) (n=1252) (n=3678) (n=576) (n=480) (n=1056) 1. Meditation 1.4% 5.0% 2.6% 0.0% 0.4% 0.2% 0.00 0.08 0.08 2. General 17.2% 35.1% 23.3% 5.9% 11.5% 8.4% 0.34 0.33 0.36 3. Satyananda 9.4% 14.4% 11.1% 2.3% 5.4% 3.7% 0.24 0.38 0.33 4. Hatha 15.5% 7.6% 12.8% 12.2% 8.1% 10.3% 0.79 1.07 0.80 5. Iyengar 30.1% 21.1% 27.0% 29.2% 29.8% 29.5% 0.97 1.41 1.09 6. Dynamic 19.3% 12.9% 17.2% 28.5% 26.0% 27.4% 1.48 2.02 1.59 7. Others 6.3% 2.4% 4.9% 21.5% 18.1% 20.0% 3.41 7.42 4.08 8. Hybrid 0.9% 1.5% 1.1% 0.5% 0.6% 0.6% 0.56 0.40 0.55 Total 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

4. Results

A proportion of 0.97 (as shown for Iyengar students) means that the proportion of injury reports amongst students who said they were practising Iyengar yoga at the time of the injury, was about equal to the overall proportion of Iyengar yoga students in the survey. This suggests that students of Iyengar yoga were neither over-represented, nor under- represented in the injury reports.

By comparison, a proportion of 1.48 (as shown for students of the dynamic styles of yoga) means that the dynamic styles of yoga were over-represented in the injury reports, eg; while 19.3% of all survey respondents practised the dynamic styles, 28.5% of injury reports involved those styles. Putting this another way, students of the dynamic styles were about one and a half times more likely to report an injury than students of Iyengar yoga.

As another example, students of Satyananda yoga were substantially under-represented in the injury reports (a proportion of 0.24 or about one quarter), suggesting that Satyananda students were about four times less likely to report an injury than students of other styles.

To explain the over-representation of the ‘Others’ category in the injury reports, about one in five survey participants chose not to identify the style of yoga they were practising at the time of the injury, presumably to protect the reputation of that style of yoga. Injury reports that were not able to allocated to a style group were put into the ‘Others’ category. Therrefore, the Others category cannot be used for comparison and for that reason is not shown in Figure 4.4.11 below. It does suggest however that the remaining style groups may in fact be showing a lower proportion of injuries than was actually the case.

Figure 4.4.11 below shows a graphical representation of the proportions, taking a proportion of 1.0 as the ‘base-line’. Style groups showing below the base-line were under-represented, while style groups above the base-line were over-represented in the injury reports.

Figure 4.4.11. Proportion of injury reports by proportion of survey respondents by style group and participant group

2.5

2.0

1.5

1.0

0.5

Proportion of representation style group Proportion 0.0 1. Meditation 2. General 3. Satyananda 4. Hatha 5. Iyengar 6. Dynamic Students 8. Hybrid Teachers

4. Results

Regarding the stronger, dynamic forms of yoga, it stands to reason that as the practice becomes more physical, the rate of injury will increase. The graph shows that the risk of injury is lower in the meditative, gentle styles and higher in the stronger, more dynamic styles of yoga. This is even more so for teachers than students, evidenced by the frequency of reports amongst teachers in the dynamic styles of yoga of repetive strain and degenerative injuries from overuse.

It is also important to point out that these comparisons are calculated proportions, and cannot provide any more than a general indication of over-representation or under- representation of style groups in the injury reports compared to the style groups of all yoga survey respondents. Caution must be exercised in interpreting these results.

4.4.8. Determining a yoga-related injury rate

In light of the 2004 Medibank Private Sports Injuries Report, mentioned earlier in this report, which stated that 25% of yoga participants were injured (before the report was subsequently withdrawn), it was decided that the Yoga in Australia survey would attempt report an ‘injury rate’ for survey participants.

Participants reported many non-specific, minor, self-correcting pains and strains, often suggesting that the injury may not have been caused by yoga, but was first noticed during yoga practice. Many injuries were aggravations of pre-existing conditions.

Therefore, in order to arrive at a meaningful yoga-related injury rate, the following definition of an injury was created and applied:

Required medical treatment or other similar intervention, OR Caused prolonged pain, discomfort or suffering, OR Resulted in time off work or financial loss

Injuries were then cross-tabulated, according to whether they met any one of the three criteria above, and they:

Happened in the previous 12 months, AND Happened under the supervision of a yoga teacher AND Were a new injury (not a recurrence of a previous injury or condition)

It was decided that recurrences and aggravations of pre-existing injuries should be included in any overall yoga-related injury rate, since this mirrors the ‘real life’ situation in a yoga class setting.

4. Results

The cross-tabulation of all 1056 injuries reported by the 889 participants is shown in Table 4.4.12 below.

Table 4.4.12. Injuries reported by circumstances and participant group

Injuries Participants Description Students Teachers Total Students Teachers Total n=576 n=480 n=10 n=502 n=387 n=889 56 N=2353 N=1061 N=3414 All reported injuries, regardless of cause or severity: Happened in the previous 12 291 123 414 254 80 348 months 10.8% 7.5% 10.2% AND, happened under the 214 64 278 186 52 234 supervision of a yoga teacher 7.9% 4.9% 6.8% AND, new injury (not a 154 50 204 134 40 172 recurrence of a previous injury 5.7% 3.8% 5.0% or condition) Injuries requiring medical treatment OR causing prolonged pain or discomfort OR resulting in time off work or financial loss: Happened in the previous 12 125 62 187 109 50 157 months 4.6% 4.7% 4.6% AND, happened under the 91 32 123 79 26 103 supervision of a yoga teacher 3.4% 2.4% 3.0% AND, new injury (not a 64 25 89 56 20 75 recurrence of a previous injury 2.4% 1.9% 2.2% or condition)

The figures in the first column of the table labelled ‘Injuries’ are the actual number of injuries reported for each circumstance.

In the second column of the table entitled ‘Participants’, the injuries are related back to the people who reported them (n), and to the rest of the sample (N), including the participants who reported no injuries.

Therefore the proportion of yoga survey participants injured in the previous 12 months, including unsupervised practice and recurrences or aggravations of pre-existing conditions, was 4.6% (students) and 4.7% (teachers), as shown in the highlighted section of the table.

For injuries occurring under supervision (eg; in class) including recurrences and aggravations of pre-existing conditions in the previous 12 months, the injury rate was 3.4% (students) and 2.4% (teachers).

For new injuries only, occurring under supervision (in class) in the previous 12 months, the injury rate was 2.4% (students) and 1.9% (teachers).

However, once again, it must be pointed out that this was an opportunistic sample of people who practice yoga, presumably pro-yoga. One must then question whether people who no longer practice yoga and therefore did not complete the survey may have had a higher proportion of injuries, or whether the presumably pro-yoga respondents by virtue of their regular practice, might have been injured more.

4. Results

4.4.9. Yoga and injury - a contradiction in terms?

Many survey participants wanted to point out that yoga and injury were a contradiction in terms. Some typical participant comments were:

Swamiji always said that if you are really practising yoga injury is impossible. You injure yourself only when your mind goes elsewhere. Ambition and ego cause injury. Of all the yoga practitioners I know who practice mindfully, there is no evidence of any injury. If people are getting injured it’s either not yoga or they’re not listening to their bodies or their teachers!

Others wanted to point out the role of ego in injury. Some typical comments were:

Although the asana was directed by a teacher, I should not have done it to that extent, but I was trying to prove a point. It was ego-driven and it was my fault. My injury happened during Trikonasana as a result of instability in my body when coming out of the pose, which I was quite far into at the time. I think there was also ego involved in this... In the future I’ll try not to let my ego get a hold and back off rather than force a pose. As pointed out by my teacher, I did not injure myself while practising yoga. If I had been present in my breath and not in my ego… the real reason I hurt my back.

Others explained that yoga ‘opened up’ restrictions in the body, which could be misunderstood as injuries. A detailed but typical participant comment follows:

To say that yoga has caused injuries would not give the correct impression. The deeper my practice continues, the depth of the injuries that I am already carrying I discover. In my younger years I participated in many different sports; swimming running, cycling, surfing and volleyball. From all of these sports I have accrued injuries including sprained ankles, torn muscles, strains, over use, etc. As I have progressed in yoga over the years, I have slowly been working back through these injuries. It’s a bit like an onion as I peel back another layer in my practice. I work deeper into my body and reveal old injuries that have been lurking there. This was very much the case a few years back when I started working slowly towards developing a daily practice. As my body opens, I might stumble across an old injury that I start to work with in my practice as I slowly attempt to regain the full use of my body. It could be seen that this injury is caused by my yoga practice. I would not say that, though I would say that I am repairing an old injury and part of the repair requires me to experience some pain again in a managed manner.

Finally, it is interesting to note that men injured themselves more than women. Men represented 15.4% of the survey participants but reported 19.3% of the injuries. However, they either didn’t need, or didn’t seek, as much medical attention for their injuries as women, and also reported less pain.

4. Results

4.4.10. Teacher adjustments and inappropriate teaching

Of all the injuries reported, 9.9% (students) and 14.8% (teachers) were sustained in the context of receiving an ‘adjustment’ from a teacher. According to the students, many of these adjustments were considered unnecessary, inappropriate, too forceful, or just plain over-zealous. Some students reported ‘never going back’ to that teacher.

Some typical participant comments were:

The teacher adjusted me in Warrior 2 pose and a ligament went. I was adjusted by a teacher who pressed me towards the floor and my collar bone was damaged. I was doing Nidrasana and the teacher adjusted me a bit too much. While binding, my pec was torn. I've have had too many injuries to bore you with, many were under the guidance of teachers who were too forceful or enthusiastic adjusting postures. I also got injured twice years ago tearing hamstrings when teachers adjusted me in Upavista Konasana. Now I never let anyone adjust me in that pose. I've learnt since to take it easy...not push myself (ego again!) and not let the teacher sit on me placing their full body weight! The instructor was lifting my leg into trivikramasana (standing splits). Felt burning sensation in hamstring. Sore for 6 weeks now. There was very little limbering or warm up for this. I was convinced into it even though I was afraid of going into one, trusting the teacher I went along with it, being helped by a fellow class mate, holding me at a crucial pivot point in my back. T11 & T12 were crunched. It was nothing to do with the style of yoga. It was poor judgement on the part of the person who did the adjustment. I think there should be careful training of adjustments and awareness of consequence should be part of that. I was in Baddha Konasana and had an 80 kg teacher stand on me. I tried to tell him that I wasn't very flexible in this position but he said "less talk, more action" and stood on my thighs and tore the inner thigh muscles. My husband was really cross that I still idolised my teacher even though he caused the injuries by an over zealous adjustment. I just accepted that he didn't do it on purpose. But both injuries were painful and took a long time to heal.

Both students and teachers also took the opportunity provided by the survey to describe what they saw as inappropriate teaching. Some typical comments were:

Sometimes the teacher should take the student's word for it that she has been advised by a medical professional not to do a certain pose, and not see it as an opinion that must be proved wrong. I didn't go back to that class again. I don't like that style and feel it’s too aggressive and not respecting the body. It was only the second time I had attended that class. I should have trusted my instinct after the first class and not gone back. The teacher was too focussed on 'achieving' the posture rather than working with process. I think that too many classes are competitive with students trying to outperform each other. Some teachers tacitly encourage it.

4. Results

4.4.11. Participant comments

As for the previous sections, a selection of participant anecdotes (some humourous) related to their injury reports is shown in Table 4.4.13 below.

Table 4.4.13. Selection of participant comments

I was helping classmate to do forearm stand. She threw her legs up and hit me in the mouth. Tooth through lip. I was bending back as far as I could and popped a rib out of my sternum. Don't know name of pose - legs wide apart, fingers gripping big toes, lowering body back flat to put chin on floor - had got the lowest I had ever been, pushed a bit hard, and my hip made a very loud bang (everyone in the room heard it). My knee made a loud popping noise when in a posture. This happened to both knees at different times but both knees are fine now. Jumping legs apart for Trikonasana - perspiration on mat caused my foot to slip and cause a sprain Felt and heard it go 'ping' whilst in Warrior pose. Adductor ligament. Laceration to scalp. I passed out during a sun salutation, fell backwards, hitting my head on the wall. During Janu Sirsasana (head to knee) I felt tightness and restriction in my lower back, but continued to follow the teacher’s instructions to work deeper into the pose. When coming out of the pose I experienced a painful spasm in my lower back and was unable to get up of the floor. Doing a strong form of yoga, which put a lot of pressure on my knees, resulted in having an arthroscopy. I have put my back out on three occasions and attribute it to partly my practice and not engaging the core at all times.

I pulled the muscles in my legs by pushing too hard, against my own wishes. I did Surya Namaskar when not properly warmed up and stretched ballistically into the mountain pose. The second toe on my right foot got caught on the yoga mat and twisted when I was returning my foot to the forward position. I was performing a headstand and got a cut lip when the person next to me kicked out of his headstand. I hurt my shoulder moving house, and was taking it easy on the other shoulder but somehow managed to hurt it anyway. Doing a shoulder stand, although the teacher said never turn your head in a shoulder stand, I turned my head and strained my neck. Did a headstand without preparation, under the influence of alcohol, wearing a heavy dress made from hand bags. Crazy. (clearly this did not happen in a yoga class!) Coming out of a headstand, was startled by the phone ringing, and fell down, breaking my toe. I fell over some yoga props and broke my toe. I was so relaxed after the yoga session I was not looking where I was going and fell off the pavement getting into my car and dislocated my shoulder!

4.5. Yoga and Flow

This section of the report is contributed by Dr Sue Jackson.

4.5.1. Introduction to Flow

‘Flow’ is an optimal psychological state, characterised by total involvement in the task at hand, which has been described at length by Csikszentmihalyi372,373,374,375 and applied to the domain of sport and physical activity376. Jackson has researched flow both from a qualitative377,378,379 and a quantitative380,381 perspective. While this research has been conducted primarily in physical activity, it has also been investigated in other domains including yoga, music, and dance382. The quantitatively-based research has focused on responses to self-report scales developed by Jackson and colleagues383,384, called the Flow Scales.

There are two versions of the Flow Scales. One, the Dispositional Flow Scale-2 (DFS-2), assesses flow from a dispositional perspective; that is, the tendency to experience flow in a given context. The other version of the flow scales is the Flow State Scale-2 (FSS-2). This is a measure of flow characteristics experienced in a particular event or activity. To illustrate in the context of yoga, the DFS-2 provides an assessment of the frequency that flow characteristics are experienced in yoga, or within a particular type of yoga practice (depending on the context). The FSS-2 provides an assessment of the extent to which flow characteristics were experienced in a specific yoga practice or class.

The Flow Scales provide a multidimensional assessment of flow, and are based on the nine- dimensional model of flow developed by Csikszentmihalyi (1990). The nine characteristics of flow are described below.

372 Csikszentmihalyi, M & Csikszentmihalyi, I. (Eds.). Optimal experience: Psychological studies of flow in consciousness. New York: Cambridge University Press. 373 Csikszentmihalyi, M. (1975). Beyond boredom and anxiety. San Francisco: Jossey-Bass. 374 Csikszentmihalyi, M. (1990). Flow: The psychology of optimal experience. New York: Harper & Row. 375 Csikszentmihalyi, M. (1997). Finding flow. New York: Harper Collins. 376 Jackson, S.A., & Csikszentmihalyi, M. (1999). Flow in sports: The keys to optimal experiences and performances. Champaign, IL: Human Kinetics. 377 Jackson, S.A. (1992). Athletes in flow: A qualitative investigation of flow states in elite figure skaters. Journal of Applied Sport Psychology, 4, 161-180. 378 Jackson, S.A. (1995). Factors influencing the occurrence of flow states in elite athletes. Journal of Applied Sport Psychology, 7, 135-163. 379 Jackson, S.A. (1996). Toward a conceptual understanding of the flow experience in elite athletes. Research Quarterly for Exercise and Sport, 67, 76-90. 380 Jackson, S.A., & Eklund, R.C. (2002). Assessing flow in physical activity: The Flow State Scale-2 (FSS-2) and Dispositional Flow Scale-2 (DFS-2). Journal of Sport and Exercise Psychology, 24, 133-150. 381 Jackson, S.A., Kimiecik, J., Ford, S., & Marsh, H.W. (1998). Psychological corrrelates of flow in sport. Journal of Sport and Exercise Psychology, 20, 358-378. 382 Jackson, S.A., & Eklund, R.C. (2004). The flow scales manual. Morgantown, WV: Fitness Information Technology. 383 Jackson, S.A., & Eklund, R.C. (2004). The flow scales manual. Morgantown, WV: Fitness Information Technology. 384 Jackson, S.A., & Marsh, H.W. (1996). Development and validation of a scale to measure optimal experience: The flow state scale. Journal of Sport and Exercise Psychology, 18, 17-35.

5. Discussion

Challenge - Skill Balance According to how Csikszentmihalyi defines flow, people will experience this optimal psychological state when they perceive that the challenges of the situation and their skills are in balance, and above their average subjective experience. If skills and challenges are not in balance, people are not likely to experience flow. Instead, they will probably experience anxiety, relaxation, boredom, or apathy. Anxiety occurs when a person perceives the challenges of the situation to exceed perceived skills; relaxation or boredom results when the skills outweigh the challenges; and apathy occurs when both perceived challenges and skills are balanced and less than an individual’s average experiences. According to the flow model, the quality of an individual’s experience is most optimal in flow, least optimal in apathy, and less than optimal in boredom or anxiety.

Merging of Action and Awareness Merging of action and awareness occurs when involvement is so deep that it becomes spontaneous or seemingly automatic. Csikszentmihalyi reported that the sense of seemingly effortless movement associated with the word flow resulted in its being chosen to describe optimal experience. Individuals are no longer aware that they are separate from their actions. A person simply becomes one with the activity. Jackson found that elite athletes described this flow dimension with terms such as “being in the groove” or statements like “I am not thinking about anything…it just happens automatically.”

Clear Goals and Unambiguous Feedback These two flow dimensions, clear goals and feedback, are frequently discussed concurrently. When in flow, goals are clearly defined by planning or may be developed while engaging in the activity. When a person knows and understands the goals for an activity, he or she is more likely to become totally immersed or engaged. In addition, a clear goal allows easier processing of feedback, which provides messages that the actor is progressing with the goal. The powerful symbiosis between goals and feedback creates order in consciousness, which is at the core of the flow experience.

Total Concentration According to Csikszentmihalyi (1997, p. 31), “When goals are clear, feedback relevant, and challenges and skills are in balance, attention becomes ordered and fully invested. Because of the total demand on psychic energy, a person in flow is completely focused.” The complete focus on the task at hand stands out as the clearest indication of flow. All distractions are kept at a minimum or nonexistent, and only a select range of information is allowed into awareness.

Sense of Control When in flow, a person feels in control of the situation without worrying about losing control. An athlete interviewed by Jackson (1992, p. 19) stated, “It feels like I can do anything in that (flow) state.” The key to this dimension is the perception of control that one feels. Another athlete said, “As strange as it sounds, I don’t feel like I am in control of anything at all…my body just takes over. On the other hand, though, I feel like I am totally in control of everything.” Because of the apparently contradictory statements such as this, Csikszentmihalyi first labeled this dimension the paradox of control. The possibility of control and the sense of being able to exercise control in difficult situations characterises this flow dimension.

5. Discussion

Loss of Self-Consciousness When in flow, a person has no room for distractions or worry about how he or she is perceived by others. No self-consciousness is present; a sense of separateness from the world is overcome, which results in a feeling of oneness with the environment. The absence of self-consciousness does not mean that the person is unaware of his or her thoughts and bodily movements. Rather, it is a keen awareness that is not threatening. In essence, the self is fully functioning without the burden of the questioning voice that so often pervades our experience.

Time Transformation The perception of time may either speed up or slow down when in flow. In flow, the experience seems to distort time. For example, a distance runner in flow may not even recall what happened during a race and may perceive that it ended more quickly than it actually did. Time transformation is generally the least mentioned flow dimension in sport and exercise samples. Csikszentmihalyi has acknowledged that in some situations, being aware of the time is paramount, which could make experiencing transcendence of time difficult.

Autotelic Experience Csikszentmihalyi described an autotelic experience as the end result of flow, one that is intrinsically rewarding. Statements such as “I was on a high”, and “I really had a great experience”, illustrate the product of a flow experience. A flow state is such a positive subjective state that the individual desires to perform the activity for its own sake. When a person has stretched her or his capacity to the fullest extent, has integrated mind and body, and is fully immersed in an activity, the outcome is likely to be autotelic - an activity done for its own sake, because it provides powerful intrinsic rewards.

4.5.2. Characteristics of the sample responses to the flow scale

Survey participants were asked to complete the dispositional version of the Flow Scales, the DFS-2, and to do so in relation to the general context of ‘when participating in yoga’. This section of the survey was delimited to those participants who practised the physical aspects of yoga, eg; asana practice.

A total of 3176 responses were received to the DFS-2. For this section of the data analysis, student and teacher responses are reported together. Flow is a state open for all to experience equally, at least theoretically. To experience flow requires that challenges and skills for an individual are balanced, and at the same time, extending the individual. Because yoga is an individual practice, theoretically it should be possible for any level of yoga participant to experience flow.

Reliability of the responses of the total sample was assessed by Cronbach’s alpha, which is a measure of internal consistency of a scale with a particular sample. Alpha values above .7 are generally regarded as evidence of good reliability. In this sample, alpha coefficients ranged from .76 to .91 across the nine flow sub-scales, indicating that the scale was a reliable, or internally consistent, measure for the combined student and teacher sample.

5. Discussion

4.5.3. Relative endorsement by yoga participants of the different flow dimensions

Figure 4.5.1 shows the mean scores across the flow dimensions for the total sample. Most sub-scale average scores approached ‘4’, which signifies experiencing that flow characteristic ‘frequently’. The most endorsed sub-scale was autotelic experience, with an average score of 4.4. This is a measure of how intrinsically enjoyable an experience is perceived to be. On the lower side of sub-scale endorsement was action-awareness merging, with an average score of 3.3, which signifies experiencing that flow dimension ‘sometimes’.

This aspect of flow has something to do with people automatically doing what is required without having thoughtfully engaged in some sort of decision-making processes before or during the action. It may be that during the practice of yoga, with awareness being as central as it is to the practice, that any notions of actions being performed ‘almost automatically’, as an illustration of action-awareness merging, seem antithetical to the practice.

Figure 4.5.1. Relative endorsement by yoga participants of the different flow dimensions

Yoga and Flowg 5

3 Mean RatingMean Mean RatingMean

1 ll lll s n iil s ll s n o s n n o s c e k n s a u io s o ii w o ti trtr e ii ll c S ii e o o t tt o // tt a n n e n lol n G u k rr e a tt e c e c tt o ff s e F r r g c o ii g A r ii a n C o u m m tt rr ll a a b ii rr n e b b e ff s o u e a e lle ii T o tt ll w m d c o s ff A p ll c o A C a e n o s s x a e s T n e o L n E T h F s n U C n o a C n o rr e c -- T f S llf e S

5. Discussion

4.5.4. Comparison of flow responses of yoga participants to a normative physical activity-performance sample

Figure 4.5.2 shows how the survey participants responded to the flow scale in comparison to an aggregate normative sample of approximately 1600 respondents. This comparison sample (Jackson & Eklund, 2004) was comprised primarily of sport respondents, but also included exercise, music and other arts participants.

It can be seen from Figure 4.5.2 that the overall pattern of endorsement of the flow sub- scales between the two groups was similar. However, there were several sub-scales where there were significant differences (marked with an ‘*’) between the samples. Across most of these sub-scales, the yoga sample had significantly higher mean scores than the normative sample of Jackson & Eklund. These differences were particularly apparent for the flow dimensions of autotelic experience, loss of self-consciousness, and time transformation. For both samples, autotelic experience was rated most highly across all flow dimensions. For the yoga participants, endorsement of their activity being intrinsically rewarding was particularly high. It was on the dimension of loss of self-consciousness that the difference between the two samples was most marked. While the yoga participants endorsed this dimension as occurring ‘frequently’ in their practice, for the normative activity sample, this endorsement was at the average level. This difference may have to do with yoga being individually- focused and non-competitive, and thus resulting in less concern from individuals regarding how they are doing in the eyes of others than in the outcome and competitively-oriented arena of sport. The third dimension rated more highly by yoga participants was time transformation. Unlike many other activities, in yoga time often dissolves into the background during practice.

Figure 4.5.2. Comparison of flow responses of yoga participants to a normative physical activity-performance sample.

Mean DFS2 scores for Yoga and JE2004 sample 5 Yoga JE2004 *

* ** 4 * * * *

3 Mean Rating Mean Rating Mean

1 s s ll l s ll s n l e n ii ll s o o s u io o n o w k n s a u ti ff ii c e s o t trtr s tt ii o S o o a o ll c ll // ii e u k r n u e a e tt G r e n F e n g c tt o s o tt c e r ii ii m m e ll g e a n C s ii rr o ii n A r a b e c tt rr a a e b ff o T o tt e lle d c s ff u e ll m o L n o ll w e n n s A p C a T a A n e o e o n x T c h F C s - a E U - rr C n lff l T e e * p < .001 S S YOGA JE2004

5. Discussion

Three dimensions where yoga participants scored lower than the normative sample were action awareness merging, clear goals, and unambiguous feedback. The lower endorsement of action awareness merging, as has previously been discussed, may have to do with yoga participants retaining a stronger awareness of their movements than other physical activity participants. Clear goals and unambiguous feedback may be central to the performance of physical activity participants, but less relevant to yoga participants. For example, in sport, the participant obtains evaluative feedback regarding how they are doing without having to think about it - it is just there. This may occur less readily in yoga, except perhaps with experienced practitioners who are attuned to receiving internal feedback regarding their movements during performance of an asana.

4.5.5. Summary of flow responses

This brief summary of the responses to the flow scale in the survey demonstrate that flow is a state both understood, and endorsed, by yoga participants. Csikszentmihalyi (1990) wrote that yoga may be “one of the oldest and most systematic methods of producing the flow experience” (p. 106), and that both flow and yoga have a strong similarity, with both aiming to achieve “a joyous, self-forgetful involvement through concentration, which in turn is made possible to a discipline of the body.” (p. 105) Through the inclusion of the flow scale in the yoga survey, the knowledge base of flow has been extended, and some insights into an optimal psychological state underlying yoga practice have been obtained.

5. Discussion

5.1. Introduction

At the time of writing, the yoga in Australia survey was believed to be the largest survey of yoga undertaken worldwide, with 3836 respondents each spending about 30 minutes completing 20,594 modules (pages) of on-line questions. This resulted in the electronic storage of over 500 variables per participant. Each variable, or set of variables, was able to be cross-tabulated, resulting in many thousands of possible combinations. Therefore, this report only presents an analysis of the most relevant frequencies, percentages, and cross- tabulations of the primary questions in the data. Likewise, this discussion focuses on a selection of issues arising from the data that were seen to be of the greatest relevance or interest.

5.2. Strengths and weaknesses of this study

Strengths Large national response Comprehensive questionnaire Canvassed both teachers and students - able to compare characteristics Seen as a unifying event for the yoga community Results prompted significant media attention to the benefits of yoga practice

Weaknesses The sample was not random; therefore, cannot be said to be representative of the Australian population Participants were self-selecting, therefore the results cannot be said to be representive of all people who practice yoga in Australia Definitions of yoga-related terms used in the questionnaire were not provided; therefore, participants may have interpreted those terms differently The survey only addressed meditation in the context of yoga; therefore, any conclusions relating to meditation must be interpreted in that light

Other weaknesses related to potential sources of bias are shown below

5.3. Other potential sources of bias

Potential sources of bias relating to the web-based delivery of the survey and the recruitment methodology were detailed earlier in the Methodology section. Other potential sources of bias are identified as follows:

Participants were people who practice or had practised yoga, and who had sufficient interest in yoga to participate in the survey; therefore, can be assumed to be predominantly ‘pro-yoga’ Responses of participants may be assumed to reflect real life experience, but the effect of participant recall and self-report cannot be discounted

5. Discussion

5.4. Considerations in interpreting the data

Yoga survey participants were not a random sample of the Australian population, nor were they a random sample of all Australians who practice yoga. Therefore it is not possible to extrapolate the findings to all yoga practice in Australia. However, it is thought that the results of certain questions, depending on context and susceptibility to recruitment bias, may be generalisable to Australians who practice yoga. For example, a question like, ‘Please describe your style of yoga,’ would be more susceptible to bias generated by the recruitment methodology than, ‘Please describe the reasons why you practice yoga.’ This is because some yoga studios and associations were more proactive in promoting the survey to their teachers and students than others.

In the same way, there are other considerations relating to interpretation of the data not apparent at first glance. For example, throughout these results, nine ‘selected styles’ were chosen for comparison by virtue of their participant numbers exceeding 100 (n>100), taken as a mininum number for meaningful analysis. One of those styles, Yoga Synergy, is a Sydney-based studio; another, Gita International Yoga, is Melbourne-based. This then has the potential to introduce geographic and socio-economic influences, amongst other things, into the responses of those people.

Therefore, caution must be exercised in extrapolating results to any larger population from any category or sub-category of the data. This is especially true for categories with low numbers of respondents.

Another consideration is that students in the yoga survey generally first started practising about nine years earlier, of which nearly six years were regular practice. They usually practised one or two times a week (56%) with another 35% practising more frequently than that, for 60 minutes or longer each session (74%). Therefore, it must be said that yoga survey participants were generally committed yoga practitioners and the results of this survey should be seen as the results of long-term, regular yoga practice.

5.5. Meditation - an integral part of yoga

One participant asked, “I am wondering why you have separated yoga and meditation? Are they not part of the same practice?” That is of course true. For example, in Raja yoga philosophy, the postures are effectively a ‘tool’ to prepare the body (and the mind) for the discipline and sometimes, the rigour, of sitting in meditation for extended periods of time.

However, in designing this study, it was acknowleged that there are some yoga practitioners who do not include meditation in their practice (or pranayama, bandha, mudra and other techniques for that matter) and there are also some yoga practitioners who exclusively practice the meditative aspects of yoga. Therefore the questionnaire referred to meditation, in the same way as it referred to asana and pranayama, as if distinct practices, in order to better understand the characteristics of respondents in these areas. This was also discussed in Section 1.2.

Finally, meditation is often practised without any connection to yoga. One of the limitations of this study was that such people were not recruited; therefore, any information about meditation collected by this survey should be taken as meditation in the context of yoga.

5. Discussion

5.6. Comparison between yoga teachers and their students

Throughout this report, results have been reported separately for yoga teachers and their students. This was primarily to ensure that results for yoga participants (students) were not confounded by the inclusion of yoga teachers in those results.

Given that yoga teachers had on average, practised yoga for 7.7 years longer, and had 6.5 years more regular practice than their students, it was thought that an ability to compare the results for teachers and students would provide an additional level of understanding of the effects of long-term, committed yoga practice, with the additional effect of the teachers’ vocational interest in yoga.

This proved a useful comparison throughout. For example, as a group, teachers reported that their medical conditions and quality of life were more improved than their students while in other questions, teachers’ responses were very similar to their students. This suggests a strong additional health and well-being benefit of longer practice.

5. Discussion

5.7. Characteristics of yoga practice in Australia

The aim of this research was to develop a detailed picture of yoga practice in Australia. There was little existing Australian data for comparision. However, some comparisons were able to be made with overseas studies.

5.7.1. Unclear participation rate for yoga

The literature review found that the most recent estimates for yoga participation as a physical activity in Australia in 2006 ranged from 1.7% of the population (ABS) to 2.9% (ERASS). However participation could have been as high as 7% (supervised practice) or 12% (all practice) in 2006, according to the RMIT polulation study into use of CAM referred to earlier. This highlights that all yoga participation is unlikely to be captured by national population-based studies into physical exercise. No existing data was found in relation to the practice of yoga as a spiritual path.

Figures from the ABS and ERASS were conflicting, but suggest that participation in yoga as a physical activity may have peaked in 2004-2005. The cause of the subsequent reduction in participation in 2006 is unknown but was in an environment of reductions in a number of sports and physical activities and in the overall participation rate. The 2007 ERASS data suggested that yoga participation was remaining steady at the 2006 level.

Overseas, yoga participation has been growing rapidly, but the most recent figure was 7.5% of US adults in 2004-05 from Yoga Journal; therefore, once again it is not possible to say whether participation in the US rose or fell in 2006-07.

5.7.2. Trend towards younger participation

Referring again to the Yoga Journal and American Sports Data (ASD) studies discussed in the literature review, the average age of yoga participants in the US has been falling. Yoga Journal reported that the 18-24 age group was the fastest growing in 2004-05. Further, 80% of practitioners had practised for less than 2 years, suggesting many new converts to yoga. Confirming this, ASD found that between 1998 and 2002, the average age of yoga participants fell by 4.4 years to 37.1 years old.

In Australia, the only existing data was from the ABS and ERASS reports, both of which suggested that the 25-34 and 35-44 age agroups were responsible for most of the yoga participation. In the case of the ERASS data, the growth in yoga participation to 2005 was shared between these age groups but also seen in the 45-54 age group.

Similarly, the mean age of yoga survey participants was 41.4 years (students) and 43.6 (teachers), with the largest proportion of students in the 25-34 and 35-44 age groups; suggesting that the average age of yoga participants in Australia may also be falling, but it is not possible to quantify this without earlier data for comparison.

Bikram (hot) yoga recorded the youngest participants (33 y.o.), followed by Ashtanga (35 y.o.), and Yoga Synergy (36 y.o.); suggesting that if the average age of yoga participants is falling in Australia, it may be as a result of growth in the dynamic styles of yoga - given that the mean ages for Contemporary Classical and Satyananda yoga were 45 and 46 years respectively by comparison.

5. Discussion

5.7.3. Proportion of women to men in yoga

In 2002, the ABS data put the proportion of women to men in yoga at 85%. Although the proportion of men varied in the intervening years, in 2006 both the ABS and ERASS agreed that the proportion of women in yoga had increased to about 90%, suggesting that yoga is still predominantly a female domain. Similarly, yoga survey participants were found to be 85.5% female.

The yoga survey found that the proportion of men varied considerably by style. Yoga Synergy had the highest proportion of men (23%), then Bikram (20%), followed by Iyengar (16%), and Ashtanga (15%). There may be other styles with a higher than average proportion of men, but not with sufficient numbers in the yoga survey to make any statements about them. Overall, male participation in the group comprising all the stronger, more dynamic styles of yoga was 18.3%, compared to 11% in Satyananda yoga and other contemporary classical styles, and 7.5% in Yoga in Daily Life.

In the US, the participation of men in yoga was higher, perhaps due to the popularity of dynamic styles of yoga. The Yoga Journal studies put the overall proportion of men at about 23% and reported that the most popular styles of yoga were Vinyasa Flow, Ashtanga, Iyengar, and Power Yoga. In England, the Manchester Yoga Survey (Iyengar yoga) reported that 88% of participants were women with a mean age of 44 years; similar to Iyengar practitioners in the Australian yoga survey, who were 84% female with a mean age of 42 years.

5.7.4. Health benefits of yoga practice The yoga survey found that students were very likely to be tertiary educated (81%) with more than one third at post-graduate level, employed (82%) including full-time, part-time or self-employed, with a household income of $50,000 or more (75%). A quarter of students had a household income of $110,000 or more.

This was similar to the US where Yoga Journal found that 40% of yoga participants had some college education, another 50% had completed college or higher, and 45% had an income of US$75,000 or higher. These findings suggest that yoga predominantly appeals to people who are tertiary educated and employed.

Students in the yoga survey had a preference for organic (49%), low GI (57%), low fat (64%) foods, and a tendency towards vegetarianism (22%). Some indicated that yoga practice had influenced their lifestyle and dietary choices. For example, nearly one third of students who said they were vegetarian also said that their decision to become vegetarian had been influenced by their yoga practice. However, it seems likely that people attracted to yoga may already exhibit health-conscious dietary and lifestyle preferences.

Interestingly, about one in seven students (14%) were employed in a healthcare occupation; most commonly, nursing, massage, and psychology, suggesting high levels of acceptance of yoga amongst healthcare professionals.

Overall, 83.5% of students in the yoga survey said they were non-smokers, with one in ten of those respondents reporting that their yoga practice contributed to their decision not to smoke. It may be that people attracted to yoga are already likely to be non-smokers, therefore one would expect the non-smoking rate in yoga to be higher than the national average. It could also be influenced by a number of other factors such as demographic and socio-economic characteristics, eg; employment and household income.

5. Discussion

However, if the one in ten who said their decision not to smoke was ‘influenced by yoga’ are removed from the 83.5%, the proportion of non-smokers in the survey would theoretically have been 74.6%, closer to the national non-smoking rate of 77% in 2005 published by the ABS385. This may suggest that yoga practice exerts a non-smoking influence on participants, supported by reports from survey participants of giving up smoking as a result of yoga practice. However, there are too many unknown factors to make statements to this effect.

The same ABS data indicates that the national smoking rate has fallen by two percentage points over ten years, and that savings associated with avoided deaths and disability, due to reduced tobacco use in Australia over the last 30 years, are in the order of $8.6 billion.

Therefore, there may be a monetary cost benefit to the Australian healthcare system, and a human cost benefit to the Australian community, of a reduction in smoking of just a couple of percentage points within the yoga community if such a reduction can be shown to stem from yoga practice. Further, well-designed national research in this area is required to quantify whether such an effect exists, and if so, the cost benefit, and to better understand the mechanism by which yoga practice may exert a non-smoking influence.

Therefore, as for not smoking, it is reasonable to suggest that there may also be a cost benefit to the healthcare system and community due to the apparent influence of yoga to engage in healthy, low fat eating, vegetarianism, and reduced alcohol consumption. For example, 18% of non-drinking students in the yoga survey attributed their decision not to drink to yoga practice. Many others reported reduced alcohol consumption. However, as for non-smoking, it is not possible to make any definitive statements to this effect.

Students in the yoga survey were also much more likely than the general population to engage in other forms of exercise and more likely to meet the National Heart Foundation guidelines for exercise. For example, 92% of yoga survey participants walked for exercise, compared to 36% of the population in the ERASS report. Of the top five physical activities in Australia, students in the yoga survey were about three times more likely to engage in walking, swimming, cycling and running than the general population, and equally as likely as the population to participate in aerobics. It may be that people attracted to yoga already have a tendency to engage in higher levels of exercise than the general population, but it seems that yoga practice may also exert an influence.

The benefits to individual and societal health and well-being of regular yoga practice appear to be substantial, with further research needed to quantify the benefits and better understand the mechanisms.

5.7.5. Components of yoga practice About 61% of the time students spent practising was devoted to physical practices like postures and dynamic posture sequences, while about 30% of their time was devoted to breathing techniques (pranayama), meditation, and relaxation. Another 9% of the time spent practising was devoted to discussion, receiving instruction, studying philosophy and other techniques, suggesting that yoga in Australia is a healthy mix of the many holistic practices in yoga.

385 Australian Bureau of Statistics. 4831.0.55.001 - Tobacco Smoking in Australia: A Snapshot, 2004-05. http://www.abs.gov.au/AUSSTATS/[email protected]/Lookup/4831.0.55.001Main+Features12004-05?OpenDocument. Accessed 10/2/08.

5. Discussion

5.8. Yoga, spirituality, and meaning

The review of the literature found no population-based studies of yoga as a spiritual path or as a way of life, yet some people practice yoga primarily for these reasons and may not be reported in studies of yoga as a form of exercise or complementary therapy.

Religiosity and church-going were shown earlier in this report to enhance subjective well- being, health and longevity and to reduce all-cause mortality. This effect is thought to stem from the ‘inherent’ or spiritual aspect of religiosity, and from the connectedness and social interaction resulting from participating in organised religion. Health benefits of church-going included reduced incidence of depression and suicide, quicker recovery from depressive illness, reduced incidence of drug and alcohol abuse, and reduced risk for conditions such as high blood pressure, heart disease, and cancer.

The yoga survey found that while only 19% of students initially saw yoga as a spiritual path, this increased to 43% once practising. However, this was found in the context of co- motivations such as wanting to improve health and fitness, to reduce stress and anxiety, and to address specific medical conditions. Therefore, while providing a useful indication of spiritual motivation, it does not establish the proportion of survey participants who primarily practised yoga as a spiritual way of life. It does however allow us to suggest that people may come to yoga for the physical but stay for the spiritual.

As an indication of the role of yoga in providing a source of meaning, the religious orientation of yoga survey participants in their first year of practice was found to be quite different from the general population (43% Christian, compared with 68% in the 2002 Census). The difference was likely due to the 23% of survey participants who said they held ‘spiritual but non-religious’ beliefs, suggesting that yoga appeals to people who do not identify with traditional western religions. This also suggests that the non-religious spirituality available in yoga may provide an accessible source of greater meaning (and therefore subjective well-being) for those people.

From the medical literature, one view of the need for an accessible form of non-religious spirituality in the community reads as follows; “Maybe a balanced form of spirituality which is not scientifically naive nor culturally intolerant may be a prerequisite for the mental and material well-being of an all too often dispirited community.386”

More interesting, however, was the trend away from identifying with Christianity (from 43% down to 28%) and towards non-religious spirituality (from 23% up to 30%) with each year of practice from one to seven years. Likewise, those with Buddhist beliefs increased from 4% to 9% over the same period, suggesting that regular yoga practice may have an impact on the religious and spiritual orientation of participants over time.

This trend away from identification with Christianity over seven years of practice appeared to stabilize and to some extent reverse over subsequent years, suggesting that in the longer term, the spiritual path offered by yoga may integrate with traditional religious beliefs. There are of course too many unknown factors to make any definitive statement, for example the trend may just have been a reflection of declining community interest in Christanity over the 7 years to 2006.

386 Hassed CS. Depression: dispirited or spiritually deprived? Med J Aust. 2000 Nov 20;173(10):545-7. http://www.mja.com.au/public/issues/173_10_201100/hassed/hassed.html. Accessed 14/2/08.

5. Discussion

Therefore, it could be argued that with somewhere between 3% and 12% of the population practising yoga, and with yoga appealing to those who identify less with the traditional religions, the spirituality found through yoga practice may provide a valuable influence on the burden of illness and disease in Australia, in a similar way to the protective effect provided by religious participation. It is not currently possible to quantify this effect, except to acknowledge that in dollar terms and human terms, the benefit could be substantial, especially in the area of mental health.

There is a need for research specifically designed to establish the extent to which yoga participants may benefit from their practice in the same way as church-goers, and therefore to quantify the benefit to the Australian healthcare system and community.

5. Discussion

5.9. Therapeutic use of yoga

The literature review found limited information on participation in yoga as a CAM therapy in Australia, with one RMIT study suggesting that between 7% and 12% of Australians use yoga therapeutically. This compares with the NCCAM study in the US described earlier, in which yoga was one of the ten most commonly used CAM therapies, with 7.6% and 5.1% of the population having used meditation and yoga respectively in the previous 12 months.

Yoga survey participants had two opportunities in the questionnaire to indicate the extent to which they used yoga as a therapy. Firstly, about 20% of both students and teachers said that one of their reasons for starting yoga was for a specific health issue or medical condition. This figure remained constant as a reason for continuing across both groups. Later in the survey, participants were asked to think of any health or medical conditions for which they had used yoga, and to rate the perceived effect of their practice on that condition. About three quarters of students (76%) and 81% of teachers completed this question, which was intended to capture information about all therapeutic use of yoga-- whether intended, or perhaps later discovered as an unexpected benefit of practice, such as a reduction in stress or improvement in sleep.

Therefore, despite the much larger response to the second question about all therapeutic uses of yoga, it is considered that the 20% response to the first question was a better indicator of the proportion of survey participants who intentionally used yoga for the management and treatment of health and medical conditions.

It is widely accepted in the literature that use of complementary therapies is increasing, led by educated, professional women387 (similar to the profile of a typical yoga survey participant), and that a perceived lack of ‘holism’ in western medicine has been a central reason why people increasingly look outside the biomedical model for their healthcare388. However, in the absence of any formal system of referral to yoga from the healthcare professions, this suggests that people are self-prescribing yoga for their health concerns.

Yoga survey participants confirmed the areas in which yoga is seen by consumers to be beneficial, by reporting mental health issues (stress, anxiety, depression and sleep difficulties) as most commonly assisted by yoga. This was followed by musculoskeletal, womens health, gastrointestinal, and respiratory conditions. Further, the perceived benefit of yoga on these conditions was quite profound, with 95% of conditions improved and 4.5% unchanged. Perceptions of improved quality of life were more dramatic, adding weight to the earlier suggestion of the potential cost-benefit to the Australian healthcare system of yoga practice, but further rigourous research is needed to quantify this given that self- reporting of perceptions of quality of life may have been affected by a range of factors.

As discussed earlier in this report, the medical and scientific research activity into yoga was seen to be most prevalent for the conditions for which yoga survey participants reported using yoga, and for which yoga has traditionally been prescribed over the centuries. This suggests that the western world is now discovering about yoga what has been known in the east for thousands of years.

387 MacLennan AH, Wilson DH, Taylor AW. The escalating cost and prevalence of alternative medicine. Prev Med. 2002 Aug;35(2):166-73. 388 Astin J. Why patients use alternative medicine: results of a national study. JAMA 1998;279(19):1548-53.

5. Discussion

5.10. Yoga for cardiovascular disease

There is compelling evidence in the medical literature for yoga-based lifestyle intervention in cardiovascular disease (CVD). As explained earlier, yoga lifestyle is not yoga postures per se. Lifestyle interventions based on the holistic principles of yoga, such as stress management (eg; yoga relaxation) regular moderate exercise (eg; walking and yoga postures), a low fat vegetarian diet, social and spiritual interaction, and smoking cessation, have proved consistently successful across a number of studies - not only reducing the risk factor profile of CVD patients, but in reversing coronary atherosclerosis.

There is a second tier to the evidence for yoga in CVD. Interventions focusing on daily yoga practice, incorporating postures, breathing techniques and meditation, have, without the other lifestyle elements, also been shown to be consistently successful in reducing blood pressure, total and LDL cholesterol (while raising good HDL cholesterol), and reducing other measures of oxidative stress, which are all primary risk factors for heart disease. At the same time, the daily or 2-3 times weekly physical practice most commonly used in those interventions, may also address issues of inactivity, social isolation, depression, and depending on the intensity of the practice, weight management. Each of these factors are also primary risk factors for heart disease.

It is probably fair to say that a similar beneficial effect on risk factor profiles could be achieved through a number of other physical activities. However, it seems that the unique balance of physical, mental, emotional, and spiritual benefits available in yoga provides an effective, ready-made solution to the risk factors that underlie many of the major causes of disease and disability in our society.

Therefore, it comes as a concern that availability of yoga-based lifestyle interventions, and yoga-based risk-factor interventions, seem to be lacking in the Australian community. Lifestyle change educational programs commonly exist in cardiac rehabilitation units, and these programs may or may not include yoga and meditation. Few preventative or lifestyle change maintenance programs exist outside of the hospital and rehabilitation system. For example, programs which are suitable for, and accessible to, the average ‘walking heart attack’, who is a person with some or all of the risk factors for heart disease.

Confirming this perceived lack of practical application of the research evidence, cardiovascular health was the least of the conditions reported by yoga survey participants. Only 3.8% of conditions reported by participants related to the management or treatment of cardiovascular conditions, and of these, most commonly reported were blood pressure management (66%) and metabolic syndrome/diabetes (8%).

This lack of uptake of the research evidence may be due to a lack of awareness of the research amongst the yoga teaching community; or it may be due to a ‘lag-effect’, being the elapsed time between the evidence being seen as unequivocal and the development and implementation of such programs.

Yoga already enjoys the confidence of the medical profession, as evidenced by the RMIT national survey of GPs described earlier, in which yoga and meditation were seen by GPs to be similar in both safety and effectiveness to massage, acupuncture and hypnosis; and with one in ten doctors practising yoga themselves. This was re-iterated by yoga survey participants, with about one in seven employed in a healthcare occupation, confirming high levels of acceptance of yoga amongst healthcare professionals. The most commonly reported healthcare occupations were nursing, massage and psychology.

5. Discussion

This suggests an important role for the community of yoga teachers in Australia; to form partnerships with general and cardiology practices in the design and delivery of evidence- based, risk-factor and lifestyle interventions for CVD, insulin resistance synrdrome, diabetes, overweight, smoking cessation, and of course, mental health, discussed in the next section.

It does not seem unreasonable to envisage a future in which the local yoga studio is commonly seen to be the place to go for educational, preventative, and interventional programs of this nature. However, there is currently no formal system of co-ordination, referral or case management between the medical and yoga teaching professions, suggesting a profound need for better integration in this area.

5. Discussion

5.11. Mental health and musculoskeletal health

Yoga survey participants reported that they used yoga more for stress management than for the traditional ‘bad back’. In the question about health issues and medical conditions, a total of 1137 participants cited ‘to reduce stress’, compared to 1088 participants who listed back pain or other back problems.

Overall, a composite number of 2694 mental health-related conditions (including stress management) were listed by yoga survey participants, compared to 2073 conditions listed in the musculoskeletal category. This suggests that mental health issues may have overtaken the traditional physical reasons for practising yoga, reflecting the increasing burden of mental health on the Australian healthcare system.

Mental health concerns (n=2694), in order of prevalence were listed as: Anxiety 44% Stress 42% (a composite estimate) Depression 32% Sleep difficulties, insomnia 24% Headaches, migraine 12% Mood disorders 2% Panic attacks 1%

Musculoskeletal issues (n=2073), were listed as: Back pain/problems 52% Neck pain/problems 30% Shoulder pain/problems 10% Muscular pain/problems 9% Joint pain/problems 7% Arthritis 7% Scoliosis 3% Sciatica 2% Disc injuries 2%

The medical and scientific evidence-base, indicates solid and growing evidence for the use of yoga and meditation-based interventions (usually as part of a multi-disciplinary or sometimes a stand-alone approach), to address mental health issues such as stress, anxiety, sleep disorders, anxiety disorders, and depression. Meditation, for its introspective nature, may be contra-indicated in people with some depressive or personality disorders.

Likewise, there is good evidence in the literature for yoga or meditation-based interventions for chronic back pain and related problems, which presumably extrapolates to neck and shoulder pain, and some evidence of benefit for Rheumatoid and Osteoarthritis. As for cardiovascular health, mental health and musculoskeletal health programs are best supported when part of a multidisciplinary, holistic approach, or as adjunct therapy to other forms of treatment.

Once again, this represents an opportunity for the yoga teaching community to lead the way in forming partnerships with mental heath services in the design and delivery of yoga and meditation-based educational, preventative, and interventional programs; programs that are easily accessible to the members of the general public through their local yoga studio.

5. Discussion

5.12. Left-handedness and yoga

The popular left-brain, right-brain debate was discussed earlier, and a possible link was suggested between gender, handedness, and brain hemisphericity; in the same way that a link has been demonstrated between nasal airflow and brain hemisphericity.

In the yoga survey, 10% of the 3103 female participants were left-handed, in line with estimates of left-handedness in the population. By comparison, 13.7% of male participants were left-handed, but without access to definitive data on left-handedness in Australia, it is not possible to say whether this is unusual or significant.

However, when analysed by style, the left-handedness of women remained around 10% across most yoga styles, but fluctuated by style for men. Left-handedness in men increased to 17.2% in the stronger, more dynamic forms of yoga (including Ashtanga, Vinyasa Flow, Synergy, Power and Bikram), while remaining largely unchanged for women in those styles (10.6%).

As discussed earlier, yoga is a largely symmetrical practice, even more so in the dynamic forms of yoga. This suggests that there may be something about the symmetry in yoga, which when combined with the stronger, more aerobic dynamic practises, that left-handed men are pre-disposed or attracted to.

It seems from recent research that left-handed men may, to some extent, share with women an ability to engage in whole-brain activity via an increased number of fibres in the corpus callosum. If women already have this ability in abundance (compared with men), that could potentially explain why their left-handedness remained consistent across most styles; whereas the proportion of left-handed men varied, potentially in proportion to the symmetry or dynamic nature of the practice and the related cross-brain activity required, or stimulated.

Admittedly, this is little more than speculation; there could be other characteristics of left- handed men that explain the yoga survey findings. However, the unusually high proportion of left-handed males found in the dynamic styles of yoga, and the lack of any previous studies to explain this, suggests a need for further well-designed research to establish firstly whether there is such a link; and if so, to better understand the mechanism by which any link exists.

Secondly, the studies into yoga breathing and brain hemisphericity, in conjunction with the studies into handedness, hemisphericity and corpus callosum size, suggest that future research into yoga breathing techniques must account for gender and handedness as potentially confounding factors.

5. Discussion

5.13. Yoga-related injuries

The Yoga in Australia survey collected detailed information on 1056 injuries, thought to be the most extensive analysis of yoga-related injuries undertaken worldwide.

Participants were encouraged to report any injury that may have related to their yoga practice, whether recent or not, recurring, self-inflicted, or minor. The intention was that the ‘real’ injuries would be able to be identified by the researchers in determining a rate of injury, while the sheer bulk of the injury reports would provide valuable data relating to the practices most commonly involved in injury, however caused.

A number of issues for discussion emerged from the data analysis:

Yoga-related injury rate The injury rate amongst yoga survey participants (injuries that occurred in the previous 12 months under supervision) was 3.4% overall, or 2.4% without the inclusion of recurrences of pre-existing conditions. Based on the large number of injury reports received from practitioners of many styles of yoga in the survey, it seems reasonable to suggest that the experience of survey participants likely reflects the experience of most people who practice yoga. However, people who stopped practising yoga due to injury or dissatisfaction were likely to be under-represented in the yoga survey due to the recruitment methodology. Therefore, there is a need for research with a statistically representative sample of the Australian population to arrive at a meaningful injury rate for yoga. This research, if conducted, would also need to be on a large enough scale to accurately identify the practices involved in injuries.

Injury prone postures Headstands (sirsasana), shoulder stands (sarvangasana), lotus posture (padmasana), and strong forward bends (eg; Uttanasana), were the practices most commonly involved in injuries. Given that headstands, shoulder stands, and lotus position are not included as standard practices in many yoga classes, the frequency of mention of those postures sends a clear message of concern.

Achieving the posture A common thread of concern in relation to Padmasana emerged. There is a perceived ‘ideal’ amongst many yoga participants to be able to sit in lotus position, or presuming this has been achieved, to sit in lotus for extended periods of time over many years. Another source of this pressure came from the class setting (peer pressure), reflected in statements such as ‘everyone else was doing it’. It bears suggestion that western bodies may not be universally suited to positions more appropriate to the eastern physiology, and that a sense of pressure or a desire to achieve the ‘look’ of yoga may be harmful, especially when there are alternative postures available.

5. Discussion

Zealous teachers and teacher adjustments Many participants took the time to complain about what they saw as over-zealous teaching (zealous was the actual word commonly used) and inappropriate adjustments received from their teacher. A common theme was teachers ‘pushing’ their students, albeit tacitly at times, to perform postures the participants felt were beyond their means, to ‘work through the pain’, or applying an inappropriate or unexpectedly strong adjustment. More specifically, a full 10% of all the injuries reported (whether minor or serious), were received in the context of receiving an adjustment from a teacher. Teachers should be on notice about this.

The role of ego in injury Yoga survey participants were unanimous about the role of ego in injury. They commonly took the blame on themselves for ‘pushing to hard’ or ‘overstretching’. “My ego made me do it,” was a common theme. Despite the willingness of the practitioners to accept fault, it seems that if there is a supervising teacher in attendance, some responsibility to design classes and utilise teaching techniques that counteract both ego and peer pressure, must rest with the teacher.

Opening up restrictions in the body Many survey participants explained that the ‘injury’ they reported was in fact a natural process of discovery, opening up, adjusting, re-aligning, and repairing sometimes hidden restrictions and injuries in the body. This was seen by participants as a necessary, although sometimes painful, benefit of their yoga practice. Based on the large number of participants who specifically mentioned this, this process needs to be understood and respected as part of yoga and probably any physical practice.

Stronger, dynamic styles of yoga It stands to reason that as the practice becomes stronger and more physical, the rate of injury will increase. Stronger styles of yoga were over-represented in the injury reports, amongst both students and teachers but substantially more for teachers; commonly through repetive strain injury of frequent, strong practice. Either way, the injuries were real, sometimes serious, and very often progressive or degenerative, such as gradual increasing hypermobility of the elbows and knees, or increasing sublaxation of the lumbar and cervical spine.

5. Discussion

5.14. Participant comments

Each module of the yoga survey provided opportunity for participants to write anecdotal comments. Over 120,000 words were written by participants, many describing inspirational, life-changing experiences. Some described the way in which yoga had enhanced their all- round health, from average to good, or from good to excellent. Some reported that they had de-stressed, given up smoking, stopped eating junk food, cut down on alcohol and stopped fighting with their partner or children as a result of their yoga practice.

It seems fitting to conclude this report with a selection of those comments, shown in Table 5.1.1 below.

Table 5.1.1. Selection of participant comments

45 year old female Yoga and meditation has given me the stillness and grounded-ness I need to manage emotionally stressful times and situations. 49 year old female Now that I'm doing a daily practice, I feel like I am at my best all the time. My relationships are better and I can deal with everyday life better because I don't get so stressed about the little things anymore. 46 year old female Yoga has been the best thing I have ever done for myself! My self-esteem, fitness, flexibility, general health and well-being has improved dramatically. It has created a calmness and clarity within myself, which I had been searching for. 34 year old male Yoga has helped me take a step back, and see life, with its highs and lows, as just that -life with highs and lows. I can choose to get stressed about it, or just to observe what happens. 48 year old female All my relationships are much better off. Being 'present' was the major hurdle so now I can give my full attention to those I am with. 44 year old male Yoga has a truly holistic effect. My experience has been that it improves every aspect of my life. 43 year old female I feel as if I could bang on about yoga for years and I want to take everyone by the scruff of the neck and show them how beneficial it is. 36 year old female Yoga has assisted with severe stress and difficult personal circumstances. I find that the regular practice (breathing, meditation and asana) reminds me how important it is to relax and to take time out to just be. I wish I could bottle the feeling that I take home with me after a session. 29 year old male Generally I am a much happier, emotionally stable person, which is a change from how I was before yoga. 36 year old female I have had problems with depression for a large portion of my life. Yoga has helped me to deal with the depression and other life issues which arise and which may have previously triggered a depressive episode. 33 year old female Practising yoga increases my quality of life ten-fold. I am calmer, more balanced and more in tune with my physical and spiritual self, making me a better friend, lover and mother.

6. Conclusion

Asana and Vinyasa (postures and sequences of postures) were found to represent 61% of time spent practising yoga, however about one third of time spent practising (30%) was devoted to the gentler, more spiritual practices of relaxation, pranayama (breathing techniques) and meditation, suggesting yoga n Australia is a healthy mix of the practices in yoga.

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Saper RB, Eisenberg DM, Davis RB, Culpepper L, Phillips RS. Prevalence and patterns of adult yoga use in the United States: results of a national survey. Alt Ther Health Med 2004; 10(2):44-9. Sareen S, Kumari V, Gajebasia KS, Gajebasia NK. Yoga: a tool for improving the quality of life in chronic pancreatitis. World J Gastroenterol. 2007 Jan 21;13(3):391-7. Satyanananda Yoga Teachers Association. http://www.syta.org.au/ Accessed 8/1/08. Satyananda Yoga Academy. http://www.satyananda.net/Training/. Accessed 8/1/08. Schell FJ, Allolio B, Schonecke OW. Physiological and psychological effects of Hatha-Yoga exercise in healthy women. Int J Psychosom. 1994;41(1-4):46-52. Schmidt T, Wijga A, Von Zur Mühlen A, Brabant G, Wagner TO. Changes in cardiovascular risk factors and hormones during a comprehensive residential three month kriya yoga training and vegetarian nutrition. Acta Physiol Scand Suppl. 1997;640:158-62. Schneider RH, Alexander CN, Staggers F, Orme-Johnson DW, Rainforth M, Salerno JW, Sheppard W, Castillo- Richmond A, Barnes VA, Nidich SI. A RCT of stress reduction in African Americans treated for hypertension for over one year. Am J Hypertens. 2005 Jan;18(1):88-98. Schneider RH, Alexander CN, Staggers F, Orme-Johnson DW, Rainforth M, Salerno JW, Sheppard W, Castillo- Richmond A, Barnes VA, Nidich SI. A RCT of stress reduction in African Americans treated for hypertension for over one year. Am J Hypertens. 2005 Jan;18(1):88-98. Schneider RH, Staggers F, Alxander CN, Sheppard W, Rainforth M, Kondwani K, Smith S, King CG. A RCT of stress reduction for hypertension in older African Americans. Hypertension. 1995 Nov;26(5):820-7. Schneider RH, Staggers F, Alxander CN, Sheppard W, Rainforth M, Kondwani K, Smith S, King CG. A RCT of stress reduction for hypertension in older African Americans. Hypertension. 1995 Nov;26(5):820-7. Sciatica.org. http://www.sciatica.org/yoga_injury_survey.html. Accessed 8/1/08. Seeman T, Kaplan G, Knudsen L et al. Social network ties and mortality among the elderly in the Alameda County Study. American Journal of Epidemiology 1987;126:714-23. Sethi S, Bhargava S C. Relationship of meditation and psychosis: case studies. Aust NZ J Psychiatry 2003;37:382 Shanti Yoga. http://www.shantiyoga.com.au/. Accessed 8/1/08. Shapiro SL, Schwartz GE, Bonner G. Effects of mindfulness-based stress reduction on medical and premedical students. J Behav Med. 1998 Dec;21(6):581-99. Sharma VK, Das S, Mondal S, Goswami U, Gandhi A. Effect of Sahaj Yoga on neuro-cognitive functions in patients suffering from major depression. Indian J Physiol Pharmacol. 2006 Oct-Dec;50(4):375-83. Sharma VK, Das S, Mondal S, Goswampi U, Gandhi A. Effect of Sahaj Yoga on depressive disorders. Indian J Physiol Pharmacol. 2005 Oct-Dec;49(4):462-8. Sharpe PA, Blanck HM, Williams JE, Ainsworth BE, Conway JM. Use of complementary and alternative medicine for weight control in the United States. J Altern Complement Med. 2007 Mar;13(2):217-22. Sherman KJ, Cherkin DC, Erro J, Miglioretti DL, Deyo RA. Comparing yoga, exercise, and a self-care book for chronic low back pain: a randomised, controlled trial. Ann Intern Med. 2005 Dec 20;143(12):849-56. Shin YW, Kim DJ, Ha TH, Park HJ, Moon WJ, Chung EC, Lee JM, Kim IY, Kim SI, Kwon JS. Sex differences in the human corpus callosum: diffusion tensor imaging study. Neuroreport. 2005 May 31;16(8):795-8. Singh PN, Sabaté J, Fraser GE. Does low meat consumption increase life expectancy in humans? Am J Clinical Nutrition, Vol. 78, No. 3, 526S-532S, Sept 2003. http://www.ajcn.org/cgi/content/full/78/3/526S. Accessed 10/3/08. Singh S, Malhotra V, Singh KP, Madhu SV, Tandon OP. Role of yoga in modifying certain cardiovascular functions in type 2 diabetic patients. J Assoc Physicians India. 2004 Mar;52:203-6. Singh V, Wisniewski A, Britton J, Tattersfield A. Effect of yoga breathing exercises (pranayama) on airway reactivity in subjects with asthma. Lancet. 1990 Jun 9;335(8702):1381-3. Smith C, Hancock H, Blake-Mortimer J, Eckert K. A randomised comparative trial of yoga and relaxation to reduce stress and anxiety. Complement Ther Med. 2007 Jun;15(2):77-83. Epub 2006 Jun 21. Smith JE, Richardson J, Hoffman C, Pilkington K. Mindfulness-Based Stress Reduction as supportive therapy in cancer care: SR. J Adv Nurs. 2005 Nov;52(3):315-27. Erratum in: J Adv Nurs. 2006 Mar;53(5):618. Smith WP, Compton WC, West WB. Meditation as an adjunct to a happiness enhancement program. J Clin Psychol. 1995 Mar;51(2):269-73. Solberg EE, Halvorsen R, Sundgot-Borgen J, Ingjer F, Holen A. Meditation: a modulator of the immune response to physical stress? A brief report. Br J Sports Med. 1995 Dec;29(4):255-7. Sood A, Barton DL, Bauer BA, Loprinzi CL. A critical review of complementary therapies for cancer-related fatigue. Integr Cancer Ther. 2007 Mar;6(1):8-13.

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Sport England. Women’s Participation in Sport Factsheet. 2002. http://www.sportengland.org/womens_participation_factsheet.pdf Accessed 16 June 2004. Srivastava RD, Jain N, Singhal A. Influence of alternate nostril breathing on cardiorespiratory and autonomic functions in healthy young adults. Indian J Physiol Pharmacol. 2005 Oct-Dec;49(4):475-83. Stancák A Jr, Kuna M. EEG changes during forced alternate nostril breathing. Int J Psychophysiol. 1994 Oct;18(1):75-9. Steele J, Mays S. New findings on the frequency of left- and right-handedness in medieval Britain. 1995. http://web.archive.org/web/20021208040702/http://www.soton.ac.uk/~tjms/handed.html. Accessed 1/2/08 Steurer-Stey C, Russi EW, Steurer J. Complementary and alternative medicine in asthma: do they work? Swiss Med Wkly. 2002 Jun 29;132(25-26):338-44. Streeter CC, Jensen JE, Perlmutter RM, Cabral HJ, Tian H, Terhune DB, Ciraulo DA, Renshaw PF. Yoga Asana sessions increase brain GABA levels: a pilot study. J Altern Complement Med. 2007 May;13(4):419-26. Survey Monkey. http://www.surveymonkey.com/. Accessed 1/11/04. Swami Satyananda Saraswati. Asana Pranayama Mudra Bandha. Yoga Publications Trust, Munger, Bihar, India. 2004 Taneja I, Deepak KK, Poojary G, Acharya IN, Pandey RM, Sharma MP. Yogic versus conventional treatment in diarrhea-predominant irritable bowel syndrome: a randomised control study. Appl Psychophysiol Biofeedback. 2004 Mar;29(1):19-33. Tang YY, Ma Y, Wang J, Fan Y, Feng S, Lu Q, Yu Q, Sui D, Rothbart MK, Fan M, Posner MI. Short-term meditation training improves attention and self-regulation. Proc Natl Acad Sci U S A. 2007 Oct 23;104(43):17152-6. Epub 2007 Oct 11. Targ EF, Levine EG. The efficacy of a mind-body-spirit group for women with breast cancer: a RCT. Gen Hosp Psychiatry. 2002 Jul-Aug;24(4):238-48. Telles S, Raghuraj P, Maharana S, Nagendra HR. Immediate effect of three yoga breathing techniques on performance on a letter-cancellation task. Percept Mot Skills. 2007 Jun;104(3 Pt 2):1289-96. The Cochrane Library. Cochrane Database of Systematic Reviews. http://www.mrw.interscience.wiley.com/cochrane/cochrane_clsysrev_articles_fs.html. Accessed 15/1/08. The Rural, Remote and Metropolitan Area (RRMA) classification system. http://www.health.gov.au/internet/wcms/publishing.nsf/Content/health-workforce-bmp. Accessed 4/1/05. The Transcendental Meditation Program. http://www.tm.org/. Accessed 10/1/08. Tloczynski J. A preliminary study of opening-up meditation college adjustment, and self-actualization. Psychol Rep. 1994 Aug;75(1 Pt 2):449-50. University of Texas. MD Anderson Cancer Centre. http://www.cancerwise.org/June_2006/display.cfm?id=FD45F931-3F09-4C02-B63122B9D027316B. Accessed 15/1/08. Valliant G, Mukamal K. Successful aging. American Journal of Psychiatry 2001;158(6):839-47. Van Montfrans GA, Karemaker JM, Wieling W, Dunning AJ. Relaxation therapy and continuous ambulatory blood pressure in mild hypertension: BMJ. 1990 May 26;300(6736):1368-72. Vedamurthachar A, Janakiramaiah N, Hegde JM, Shetty TK, Subbakrishna DK, Sureshbabu SV, Gangadhar BN. Antidepressant efficacy and hormonal effects of Sudarshana Kriya Yoga (SKY) in alcohol dependent individuals. J Affect Disord. 2006 Aug;94(1-3):249-53. Epub 2006 Jun 5. Vedanthan PK, Kesavalu LN, Murthy KC, Duvall K, Hall MJ, Baker S, Nagarathna S. Clinical study of yoga techniques in university students with asthma: a controlled study. Allergy Asthma Proc. 1998 Jan- Feb;19(1):3-9. Walker ID, Gonzalez EW. Review of intervention studies on depression in persons with multiple sclerosis. Issues Ment Health Nurs. 2007 May;28(5):511-31. Walton KG, Fields JZ, Levitsky DK, Harris DA, Pugh ND, Schneider RH. Lowering cortisol and CVD risk in postmenopausal women: a pilot study using the Transcendental Meditation program. Ann N Y Acad Sci. 2004 Dec;1032:211-5. Weinert BT, Timiras PS. Invited review: Theories of aging. J Appl Physiol. 2003;95(4):1706-16. Wenneberg SR, Schneider RH, Walton KG, Maclean CR, Levitsky DK, Salerno JW, Wallace RK, Mandarino JV, Rainforth MV, Waziri R. A controlled study of the effects of the Transcendental Meditation program on cardiovascular reactivity and ambulatory blood pressure. Int J Neurosci. 1997 Jan;89(1-2):15-28. West J, Otte C, Geher K, Johnson J, Mohr DC. Effects of Hatha yoga and African dance on perceived stress, affect, and salivary cortisol. Ann Behav Med. 2004 Oct;28(2):114-8.

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8. Appendices

The pages that follow contain a copy of the survey instrument and associated website forms as described in Section 3.7. along with examples of media generated by the Yoga in Ausralia survey project.

Yoga in Australia Survey - Section 1 Page 1 of 4

a landmark national survey

This is the manual (paper and pen) version of the on-line survey at www.yogainaustralia.com. Once completed, please return by mail to PO Box 208, West Brunswick, VIC, 3055 by Friday 9 December 2005.

Please don't be put off by the number of pages! In most cases this survey takes 20-30 minutes depending on which sections you complete. There are seven main sections, two of which are optional.

SECTION 1. Your demographic information - required SECTION 2. Questions about your yoga or meditation practice - required SECTION 3. Questions about your health and lifestyle - required SECTION 4. Questions about your yoga or meditation teaching - for yoga teachers/therapists only SECTION 5. Questions about your pranayama practice - for experienced pranayama practitioners only SECTION 6. Questions about yoga related injuries - you may need extra copies of this section SECTION 7. Subjective experience in yoga (Flow) - required SECTION 8. Plain Language Statement and Privacy Policy

If you would like a complimentary copy of the results when published, please provide your email address or mailing address here.

Your email address or mailing address:

SECTION 1. Your demographic information

The demographic information is important because the rest of the survey is not much use without this information! Thanks very much in advance for your input!

Tell us a little about yourself

Please tick all the options that are applicable to you.* (* at least one option must be selected) gfedc I practice (or have ever practised) yoga or meditation

gfedc I am (or have been) a yoga or meditation teacher

gfedc I am currently training to become a yoga or meditation teacher

gfedc I am (or have been) a yoga or meditation teacher trainer

gfedc I am (or have been) a yoga therapist (teach yoga to address health concerns or medical conditions)

gfedc I am (or have been) a healthcare practitioner (other than a yoga therapist), please specify (ie: doctor, nurse, naturopath)

gfedc I am (or have been) a researcher in yoga/meditation related areas, please specify (ie: yoga for back pain)

gfedc I am a supplier of goods or services to the yoga community, please specify (ie: yoga accessories)

gfedc I don't fit into any of the categories above (are you sure? if you have ever practised yoga or meditation, please tick the first box)

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Your school and style of yoga or meditation

Which school or style of yoga or meditation do you best identify yourself with? (if known) For most people, this will be the school or style of yoga you currently practice or have practised the most.

School/Studio:

(eg: ABC Yoga School) Style/Lineage:

(eg: Iyengar, Satyananda, Contemporary Classical)

Pranayama or meditation practitioners only

Have you practised pranayama (yoga breathing techniques) or meditation? If so, please tell us if you are interested to participate in separate studies in these areas being conducted by RMIT University.

gfedc Pranayama (please complete the optional pranayama questions) gfedc Meditation (if you provided an email address, we may contact you about this in the future)

Your vital statistics!

This information will help us find out how these factors affect yoga or meditation participation. Remember, your personal information is kept strictly confidential.

(* = required) Age: * required years old (whole numbers only please, eg: 47)

Sex: * required nmlkj Male nmlkj Female Height: * required cm (click here for help with this) Weight: * required kg (click here for help with this)

Left/right handed? * nmlkj Left nmlkj Right required Pregnant? gfedc Please tick here if you are, or have been, pregnant in the last 12 months.

Your location

Country where you live:

* required

Postcode where you live:

* required

Is this an urban or rural nmlkj location? Capital city * required nmlkj Metropolitan centre (city) - more than 100,000 people

nmlkj Large rural centre - 25,000 to 100,000 people

nmlkj Small rural centre - up to 25,000 people

nmlkj Remote area

Your country of nationality if

different from the country where you live:

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Marital status

Please select the option that best describes your marital status:

nmlkj Single (includes never married, separated, divorced, widowed)

nmlkj Partnered (includes married or defacto)

nmlkj Other, please specify

Religious/spiritual orientation

Please select the option that best describes your religious or spiritual orientation:

nmlkj Christianity (including Catholic, Anglican, Protestant, Orthodox, Jehovah's Witness, etc)

nmlkj Islam

nmlkj Hinduism

nmlkj Secular (eg: atheist, agnostic, non religious)

nmlkj Buddhism

nmlkj Chinese Traditional

nmlkj Indigenous (eg: Aboriginal)

nmlkj African Traditional

nmlkj Judaism

nmlkj Spiritual / new age (eg: non-religious spiritual beliefs)

nmlkj Other religion, please specify

Level of education

Please select the option that best describes your highest level of education:

nmlkj Secondary - up to year 11

nmlkj Secondary - year 12 or equivalent

nmlkj Tertiary - diploma, degree or equivalent

nmlkj Tertiary - post-graduate

nmlkj Other - please specify

Employment status

Please select the option that best describes your employment status:

nmlkj Employed - part-time or casual

nmlkj Employed - full-time

nmlkj Self-employed

nmlkj Student (including part time or casual employment)

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nmlkj Unemployed (looking for work)

nmlkj Retiree

nmlkj Not in labour force (not looking for work)

nmlkj Other, please specify

If you answered employed or self-employed above, please select your main type of employment: (please only select one)

nmlkj Accounting nmlkj Logistics, Transport & Supply nmlkj Administration & Office Support nmlkj Manufacturing nmlkj Automotive nmlkj Marketing nmlkj Community nmlkj Media, Advertising, Arts & Entertainment nmlkj Construction & Architecture nmlkj Personal & Other Services nmlkj Customer Service & Contact Centre nmlkj PR & Communications nmlkj Defence & Essential Services nmlkj Property nmlkj Education nmlkj Retail nmlkj Engineering nmlkj Sales nmlkj Executive nmlkj Scientific nmlkj Financial Services nmlkj Self-employment nmlkj Healthcare nmlkj Trades nmlkj Hospitality, Travel & Tourism nmlkj Other, please specify nmlkj Human Resources & Recruitment nmlkj Insurance nmlkj IT & Telecommunications nmlkj Legal

Household income

Please select the option that best describes your total household income (all wage earners in your household, gross per year):

nmlkj Less than $30,000

nmlkj $30,000 to $49,999

nmlkj $50,000 to $69,999

nmlkj $70,000 to $89,999

nmlkj $90,000 to $109,999

nmlkj More than $110,000

(if your currency is not in dollars, please estimate the A$ equivalent)

Number of wage earners in your household:

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SECTION 2. Questions about your yoga or meditation practice

The questions in this section are about your personal practice of yoga or meditation. If you are a teacher or therapist, there is another section for your teaching experiences. These questions are about your personal practice only.

Your personal practice sessions

Please select the option that best describes how often you have practiced yoga or meditation in the last 12 months on average. This includes ALL practice, whether at home or in a class (supervised/guided by a teacher). Teachers - this does not include the time you spend teaching!

nmlkj 7 or more sessions a week

nmlkj 5-6 sessions a week

nmlkj 3-4 sessions a week

nmlkj 1-2 sessions a week

nmlkj less than weekly

nmlkj less than monthly

nmlkj not at all

Please select the option that best describes the average length of your practice sessions?

nmlkj less than 15 minutes

nmlkj 15-25 mins

nmlkj 30-40 mins

nmlkj 45-55 mins

nmlkj 60-70 mins

nmlkj 75-85 mins

nmlkj 90-100 mins

nmlkj more than 100 minutes

Reasons for practising yoga or meditation

Please select the options that best describe why you began practising yoga or meditation, and if different, the reasons why you continue practising: (tick as many boxes as appropriate)

Reasons Reasons for for beginning continuing gfedc gfedc Trendy, in vogue

gfedc gfedc Increase health and fitness

gfedc gfedc Increase flexibility, muscle tone

gfedc gfedc To reduce stress or anxiety

gfedc gfedc Specific health reason or medical condition

gfedc gfedc Pregnancy, childbirth

gfedc gfedc Menopause, other womens health issue

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gfedc gfedc Spiritual path

gfedc gfedc Personal development

gfedc gfedc To enhance performance in another activity

gfedc gfedc Other, please specify

Please select the options that best describe how else you were influenced to begin practising yoga or meditation: (select as many as appropriate)

gfedc Media (TV, magazine, newspaper)

gfedc Recommendation from friend or family

gfedc Referred by GP or health practitioner

gfedc Books, journals

gfedc Coach or personal trainer

gfedc Other, please specify

How many years ago did you first start practising yoga? Since then, about how many years have you practised regularly?

Styles of yoga or meditation you have practised

Which styles or lineages of yoga or meditation have you practised in the last 12 months and which styles have you ever practised regularly? (if your practice is best described as a "blend" of styles, please select all the contributing styles)

gfedc I'm not sure what styles I have practised ( please scroll down to the next question)

Styles ever Styles practised practised in regularly the last 12 months Styles of yoga, meditation and special interest areas Please note: Not all styles are able to be listed. Many of these styles can be described as Hatha yoga. Some styles of yoga include meditation. Other meditation- only styles are shown below. gfedc gfedc Ashtanga Vinyasa

gfedc gfedc Bikram

gfedc gfedc Contemporary Classical

gfedc gfedc Dru

gfedc gfedc Gita

gfedc gfedc Iyengar

gfedc gfedc Integral

gfedc gfedc Ki

gfedc gfedc Kripalu

gfedc gfedc Kundalini

gfedc gfedc Oki Do

gfedc gfedc Power

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Styles ever Styles practised practised in regularly the last 12 months gfedc gfedc Pre/post natal

gfedc gfedc Sahaja

gfedc gfedc Satchitananda

gfedc gfedc Satyananda

gfedc gfedc Shiva

gfedc gfedc Shivananda

gfedc gfedc Siddha

gfedc gfedc Viniyoga

gfedc gfedc Vivekananda

gfedc gfedc Yoga in Daily Life

gfedc gfedc Yoga therapy

gfedc gfedc Other, please specify

Meditation-only styles gfedc gfedc Buddhist meditation

gfedc gfedc Christian meditation

gfedc gfedc Generic meditation (sound, chakra, mantra, visualisation)

gfedc gfedc Osho meditation

gfedc gfedc Raja yoga meditation (eg: Brahma Kumaris)

gfedc gfedc Theosophical meditation

gfedc gfedc TM meditation

gfedc gfedc Vipassana meditation

gfedc gfedc Other, please specify

Other related activities

gfedc gfedc Pilates

gfedc gfedc Tai Chi

gfedc gfedc Qi Gong

gfedc gfedc Body Balance (mix of yoga, tai chi and pilates)

gfedc Tick here if you have not practised in the last 12 months

Meditation techniques you use

If you practice meditation, please select the techniques you regularly use in your meditation practice? (select as many as appropriate)

gfedc Breath (any form of breath exercise)

gfedc Mantra

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gfedc Visualisation

gfedc Healing meditation techniques

gfedc Prayer

gfedc Focus on a deity or guru

gfedc Movement

gfedc Sound

gfedc Other, please specify

Components of your practice sessions

Please estimate the time typically devoted to each of the following in your practice: (please see the example provided)

Example:

Asana (postures) minutes Asana 30 minutes

Discussion, instruction (verbal) minutes Discussion, instruction 5 minutes Pranayama (breathing techniques minutes Pranayama 5 minutes to direct the prana or lifeforce) Meditation (mental focus or no- minutes Meditation 5 minutes thought mindfulness) Suryanamaskar/Vinyasa minutes Suryanamaskar/Vinyasa 10 minutes (dynamic sequences of postures) Relaxation/stress management minutes Relaxation/stress management 10 minutes (ie: yoga nidra, guided relaxation)

All other practices minutes All other practises 10 minutes

TOTAL minutes TOTAL 75 minutes

If applicable, do you regularly include the following in your yoga practice?

gfedc Kriyas (cleansing and/or energy stimulating practices)

gfedc Bandhas (muscular locks or neurological and prana redirection techniques)

gfedc Mudras (gestures)

gfedc Prayers and bhajans (chanting of devotional songs)

gfedc Study of yogic texts or commentaries or other philosophical study

gfedc Attending discourses, workshops, seminars or retreats on yoga or meditation

Places where you practice yoga or meditation

Please estimate the proportion of your practice you do at home (unsupervised) compared to in class (under the supervision/guidance of a teacher):

nmlkj Only at home

nmlkj Mostly at home (70-90% at home)

nmlkj More at home than in class (50-70% at home)

nmlkj More in a class than at home (30-50% at home)

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nmlkj Mostly in a class (10-30% at home)

nmlkj Only in a class

Please indicate the locations/venues where you have attended a yoga/meditation class in the last 12 months: (select as many as appropriate)

gfedc Dedicated yoga school or studio

gfedc Ashram or similar

gfedc At work (in the workplace, corporate sponsored yoga)

gfedc School, college or university

gfedc Gym or leisure centre

gfedc Medical centre or Natural therapies centre

gfedc Home class (at your home or the teacher's home)

gfedc Church, community hall or similar

gfedc Other, please specify

Money you spend on your practice

On average, how much money do you spend on your yoga or meditation practice per month? (whole figures only please)

Attending classes $ per month

Purchasing accessories$ (eg: books, magazines, videos, DVDs, yoga mats)

Other $ please specify

(if your currency is not in dollars, please estimate the A$ equivalent)

Reasons for NOT practising yoga or meditation

If you have not practised yoga or meditation in the last 12 months (or if you practise less often than you would like to) please select the options that best describe the reasons for this: (select as many as appropriate)

gfedc Time - family commitments, lack of time, etc

gfedc Money - financial circumstances, cost of classes

gfedc Motivation - lost interest, moved on to other activities

gfedc Quality - not satisfied with teacher, style or school I was attending

gfedc Availability - no teachers or no classes in preferred style or location

gfedc No particular reason - just taking a break from practising

gfedc Other, please specify

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Any comments?

Do you have any further comments to the questions above? We would love to hear your personal story about the techniques you have used and the benefits you have received from yoga and meditation.

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SECTION 3. Questions about your health and lifestyle

These questions will help us find out the extent to which yoga is being used as a therapy for many common health issues or medical conditions and whether yoga is beneficial in those areas.

Your dietary choices

Please select the options which best describe your current dietary choices and tell us whether you were influenced to make this choice by your yoga practice. Please leave blank any that don't apply to you.

Dietary Influenced choice by yoga practice? gfedc gfedc Vegetarian

gfedc gfedc Vegan

gfedc gfedc Prefer organic foods

gfedc gfedc Prefer low sugar / low GI (slower sugar absorbtion) foods

gfedc gfedc Prefer low-fat / low saturated fat foods

gfedc gfedc Non-smoker

gfedc gfedc Non-drinker

gfedc gfedc Don't drink caffeine (coffee, tea, coke, etc)

gfedc gfedc Other, please specify

Sporting and other physical activity

Please select the sports and physical activities that you have participated in during the last 12 months by indicating how often you participated. Leave blank the activities you didn't participate in and specify any that are not listed.

Sport/physical activity How Often (on average) Daily 5-6 days 3-4 days 1-2 days less than less than a week a week a week weekly monthly

Walking nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj

Aerobics (Step, Pump, Cardio, etc) nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj

Swimming nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj

Golf nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj

Tennis nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj

Cycling nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj

Running/Jogging nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj

Fishing nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj

Bushwalking nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj

Netball nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj

TaiChi, Body Balance nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj

Pilates nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj

Aussie Rules nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj

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How Often (on average) Daily 5-6 days 3-4 days 1-2 days less than less than a week a week a week weekly monthly

Soccer nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj

Basketball nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj

Hockey nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj

Weight Training nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj

Dancing nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj

Martial Arts nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj Other, please specify nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj

Other, please specify nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj

Health issues and medical conditions

Please think of any health issues or medical conditions for which you have used yoga as part of the management or treatment of the condition. (eg: you may have used yoga to help with stress, back pain, asthma, pregnancy, to lose or gain weight, etc). Please specify each condition in the appropriate section and tell us whether using yoga was helpful or not.

gfedc I have not used yoga to address any health concerns or medical conditions (please scroll down to the next question)

Much Better Little Same Little Worse Much Better Better Worse Worse I have used yoga to address the Condition Condition Condition Condition Condition Condition Condition following: improved improved the same the same the same got worse got worse Symptoms Symptoms Symptoms Symptoms Symptoms Symptoms Symptoms improved the same improved the same got worse the same got worse Gastrointestinal (eg: irritable bowel syndrome, coeliac disease) nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj Please specify

Musculoskeletal (eg: back or neck pain, joint pain, muscular pain, arthritis) nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj Please specify

Respiratory (eg: asthma, lung or respiratory problems) nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj Please specify

Cardiovascular (eg: heart disease, high blood pressure) nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj Please specify

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Much Better Little Same Little Worse Much Better Better Worse Worse Condition Condition Condition Condition Condition Condition Condition improved improved the same the same the same got worse got worse Symptoms Symptoms Symptoms Symptoms Symptoms Symptoms Symptoms improved the same improved the same got worse the same got worse Mental Health (eg: anxiety, depression, headaches, sleep difficulties) nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj Please specify

Womens Health (eg: pregnancy, postnatal, menopause) nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj Please specify

Other (eg: stress, to lose or gain weight, diabetes) nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj Please specify

Other (anything else we forgot?) Please specify nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj

Please provide further detail to the above and tell us which practices you found most helpful or least helpful.

Perceptions of quality of life

Please indicate how your practice of yoga has influenced your perceptions of quality of life in the following areas. If you don't know or have no comment, please leave blank.

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Much Better Little Same Little Worse Much Better Better Worse Worse Spiritual Health (eg: relationship with higher power, sense of inner peace and happiness) nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj Please specify Relationships (eg: quality of close relationships, friends, family life, sex life) nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj Please specify

Any comments?

Any other comments to the questions in this section? We would love to hear your personal story about how yoga or meditation has influenced your health or lifestyle.

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SECTION 4. Questions about your yoga or meditation teaching

This section is for yoga and meditation teachers and therapists ONLY. This includes anyone who has ever been qualified to teach yoga or meditation (even if you are no longer teaching). If you are not a teacher, trainer or therapist, this section is not for you.

Your teaching sessions

Please select the option that best describes how often you have taught yoga or meditation in the last 12 months. Teachers - this does not include the time you spend doing personal practice!

nmlkj More than 10 sessions a week

nmlkj 9-10 sessions a week

nmlkj 7-8 sessions a week

nmlkj 5-6 sessions a week

nmlkj 3-4 sessions a week

nmlkj 1-2 sessions a week

nmlkj less than weekly

nmlkj less than monthly

nmlkj not at all

Please select the option that best describes the average length of your teaching sessions?

nmlkj less than 15 minutes

nmlkj 15-25 mins

nmlkj 30-40 mins

nmlkj 45-55 mins

nmlkj 60-70 mins

nmlkj 75-85 mins

nmlkj 90-100 mins

nmlkj more than 100 minutes

What is the average weekly or monthly attendance at sessions taught by you?

attendees nmlkji a week nmlkj a month

What is the average price to the public of your teaching sessions?

Group sessions: $ per minutes

Individual (one on one) tuition: $ per minutes

(if your currency is not in dollars, please estimate the A$ equivalent)

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Influences to begin teaching

Please select the options that best describe how you were influenced to begin teaching yoga or meditation: (select as many as appropriate)

gfedc Recommendation from a yoga teacher, friend or family

gfedc To earn an income

gfedc To be of service of others

gfedc As an extension of practising yoga or meditation

gfedc To further your personal or spiritual development

gfedc To enhance development in another field

gfedc Other, please specify

Styles of yoga or meditation you have taught

Which styles/lineages of yoga or meditation have you taught in the last 12 months and which styles have you ever taught regularly? If your teaching is best described as a "blend" of styles, please select all the contributing styles.

Styles ever Styles taught taught in the last 12 regularly months Styles of yoga, meditation and special interest areas Please note: Not all styles are able to be listed. Some meditation-only styles are shown below.

gfedc gfedc Ashtanga Vinyasa

gfedc gfedc Bikram

gfedc gfedc Contemporary Classical

gfedc gfedc Dru

gfedc gfedc Gita

gfedc gfedc Iyengar

gfedc gfedc Integral

gfedc gfedc Ki

gfedc gfedc Kripalu

gfedc gfedc Kundalini

gfedc gfedc Oki Do

gfedc gfedc Power

gfedc gfedc Pre/post natal

gfedc gfedc Sahaja

gfedc gfedc Satchitananda

gfedc gfedc Satyananda

gfedc gfedc Shiva

gfedc gfedc Shivananda

gfedc gfedc Siddha

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Styles ever Styles taught taught in the last 12 regularly months gfedc gfedc Viniyoga

gfedc gfedc Vivekananda

gfedc gfedc Yoga in Daily Life

gfedc gfedc Yoga therapy

gfedc gfedc Other, please specify

Meditation-only styles

gfedc gfedc Buddhist meditation

gfedc gfedc Christian meditation

gfedc gfedc Generic meditation (sound, chakra, mantra, visualisation)

gfedc gfedc Osho meditation

gfedc gfedc Raja yoga meditation (eg: Brahma Kumaris)

gfedc gfedc Theosophical meditation

gfedc gfedc TM meditation

gfedc gfedc Vipassana meditation

gfedc gfedc Other, please specify

Other related activities gfedc gfedc Pilates

gfedc gfedc Tai Chi

gfedc gfedc Qi Gong

gfedc gfedc Body Balance (mix of yoga, tai chi and pilates)

gfedc Tick here if you have not taught in the last 12 months

Components of your teaching sessions

Please estimate the usual proportion of your teaching devoted to each of the following practises: (whole numbers only please)

Example:

Asana minutes Asana 30 minutes

Discussion, instruction minutes Discussion, instruction 5 minutes

Pranayama minutes Pranayama 5 minutes

Meditation minutes Meditation 5 minutes

Suryanamaskar/Vinyasa minutes Suryanamaskar/Vinyasa 10 minutes

Relaxation/stress management minutes Relaxation/stress management 10 minutes

All other practices minutes All other practises 10 minutes

TOTAL minutes TOTAL 75 minutes

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If applicable, do you regularly use or include the following in your teaching?

gfedc Kriyas

gfedc Bandhas

gfedc Mudras

gfedc Prayers and bhajans

gfedc Study of yogic texts or commentaries or other philosophical study

gfedc Providing discourses, workshops, seminars or retreats on yoga or meditation

Places where you teach

Please indicate the locations/venues where you have taught in the last 12 months: (select as many options as appropriate)

gfedc Dedicated yoga school or studio

gfedc Ashram or similar

gfedc At work (in the workplace, corporate sponsored yoga)

gfedc School, college or university

gfedc Gym or leisure centre

gfedc Medical centre or Natural therapies centre

gfedc Home class (at your home or the student's home)

gfedc Church, community hall or similar

gfedc Other, please specify

Reasons for NOT teaching

If you have not taught yoga or meditation in the last 12 months or you have taught less often than you would have like to, please select the options that best describe the reasons for this: (select as many as appropriate)

gfedc Time - family commitments, lack of time, etc

gfedc Expenses - cost of teaching venues, equipment, costs of running business

gfedc Motivation - lost interest, moved on to other activities

gfedc Availability - not enough students wanting your style of teaching in your location

gfedc Income - not enough income from teaching to make it worthwhile

gfedc No particular reason - just taking a break from teaching

gfedc Other, please specify

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Your qualifications for teaching yoga or meditation

What qualification/s or other form of accreditation did you obtain to become a yoga or meditation teacher? We understand that traditional forms of training may have been informal - if so, please describe as clearly as you can, how you became qualified.

nmlkj formal training (ie: certificate or diploma course)

nmlkj informal training (ie: assistant or apprenticeship)

nmlkj both formal and informal training

Description of training:

How many hours of training did this represent? (if not formal training, please estimate as best you can the equivalent number of hours)

Formal training total contact hours (as advised by the instution)

Informal training hours (estimated equivalent)

What other qualification/s or accreditations (both yoga and non-yoga) do you hold or are you undertaking? (eg: certificate, diploma, degree courses)

Membership of associations and insurances

What memberships of professional associations relevant to yoga do you hold? (please note that not all associations are able to be listed)

gfedc BKS Iyengar Yoga Association of Australia

gfedc International Association of Yoga Therapists

gfedc International Yoga Teachers Association

gfedc Satyananda Yoga Teachers Association

gfedc Yoga Teachers Association of Australia

gfedc Other, please specify below:

Do you hold any of the following insurances for teaching?

gfedc Public Liability (PL) - eg: personal injury

gfedc Professional Indemnity (PI) - eg: negligence

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Do you hold any first aid or similar qualifications?

gfedc Level 1 First Aid

gfedc Level 2 First Aid

gfedc Other, please specify

Any comments?

Any other comments to the teaching questions?

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SECTION 5. Questions about your pranayama practice

Are you an experienced pranayama practitioner? If so, please tell us about your pranayam practice by answering the questions in this section. At the end of the section you will have the opportunity to volunteer to participate in a separate study to identify yoga breathing styles that may have particular health benefits.

Your breathing training

Have you ever received any form of formal or informal breathing training? If yes, please give details:

Your breathing practice

Please describe the breathing techniques you usually practice and why you use them:

I generally do this breathing practice nmlkj daily nmlkj weekly

How do you usually breathe day to day? nmlkj IN nose OUT nose

nmlkj IN nose OUT mouth

nmlkj IN mouth OUT mouth

nmlkj IN mouth OUT nose

nmlkj IN OUT both nose and mouth

Are there any other techniques you sometimes practice? If so, please describe their use and why you use them.

Muscle groups used during breathing practice

Please tick the options that best describe how you breath in and out during the following practices and whether you use Ujaii. If you like, you can also make comments about the muscle groups that you use and why you use them.

(eg: muscle groups can include abdominal diaphragmatic, rectus abdominae, lower thoracic diaphragmatic, lower thoracic intercostal, mid thoracic intercostal and upper thoracic intercostal)

Breathing in Breathing out

Asana nmlkj abdomen then chest nmlkj abdomen then chest nmlkj chest then abdomen nmlkj chest then abdomen

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nmlkj lower then middle then upper nmlkj lower then middle then upper nmlkj upper, then middle then lower nmlkj upper, then middle then lower

gfedc tick here if you normally use Ujaii during asana practice gfedc tick here if you regularly use bandhas during asana practice Comments (optional)

Breathing in Breathing out

Pranayama nmlkj abdomen then chest nmlkj abdomen then chest nmlkj chest then abdomen nmlkj chest then abdomen nmlkj lower then middle then upper nmlkj lower then middle then upper nmlkj upper, then middle then lower nmlkj upper, then middle then lower

gfedc tick here if you normally use Ujaii during pranayama practice gfedc tick here if you regularly use bandhas during pranayama practice Comments (optional)

Breathing in Breathing out

Meditation nmlkj abdomen then chest nmlkj abdomen then chest nmlkj chest then abdomen nmlkj chest then abdomen nmlkj lower then middle then upper nmlkj lower then middle then upper nmlkj upper, then middle then lower nmlkj upper, then middle then lower

gfedc tick here if you normally use Ujaii during meditate practice gfedc tick here if you regularly use bandhas during meditation practice Comments (optional)

Breathing in Breathing out

Relaxation nmlkj abdomen then chest nmlkj abdomen then chest nmlkj chest then abdomen nmlkj chest then abdomen nmlkj lower then middle then upper nmlkj lower then middle then upper nmlkj upper, then middle then lower nmlkj upper, then middle then lower

gfedc tick here if you normally use Ujaii during relaxation practice Comments (optional)

Breathing in Breathing out

Other, please specify nmlkj abdomen then chest nmlkj abdomen then chest nmlkj chest then abdomen nmlkj chest then abdomen nmlkj lower then middle then upper nmlkj lower then middle then upper nmlkj upper, then middle then lower nmlkj upper, then middle then lower

gfedc tick here if you normally use Ujaii during this practice gfedc tick here if you regularly use bandhas during this practice Comments (optional)

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Perceptions of quality of life

Please indicate how your pranayama practice has influenced your perceptions of quality of life in the following areas. If you don't know or have no comment, please leave blank.

Much Better Little Same Little Worse Much Better Better Worse Worse Physical Health (eg: fitness, muscle tone, flexibility, energy levels) nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj Please specify Mental Health (eg: memory, depression, sense of purpose or meaning, positivity) nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj Please specify Emotional Health (eg: emotional stability, anger, stress or anxiety levels) nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj Please specify Spiritual Health (eg: relationship with higher power, sense of inner peace and happiness) nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj Please specify Relationships (eg: quality of close relationships, friends, family life, sex life) nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj nmlkj Please specify

Volunteer for the pranayama "human trials"

gfedc Please tick here if you are interested in volunteering to take part in a separate study to identify yoga breathing styles that may have particular health benefits. Please provide your name and email address so the researcher can contact you.

If selected, you will be asked to complete a short medical history questionnaire and to perform simple breathing practises while measurements are taken to reveal brain wave, heart activity, muscle movements and nasal airflow, using standard, non invasive bio-medical equipment. This will take no more than two hours of your time. More details can be found here.

Name:

Email:

Your name and email address will only be used to contact you to arrange an appointment with the researcher. Your personal information is strictly confidential. Only pooled responses will be reported in survey results so that individuals cannot be identified. If you have any questions about your privacy, please read our Plain Language Statement and Privacy Policy at the end of the survey.

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SECTION 6. Questions about yoga related injuries

Please think of any injuries you have ever had that may have been attributable to your yoga practice. For each injury, please complete a separate report. If you wish to report more than one injury, you will need to make extra copies of this section and attach them to your survey.

If you haven't had any yoga-related injuries, please tick this box and leave this section blank.

gfedc I have not had any injuries that I could attribute to my yoga practice.

INJURY REPORT

Please complete a separate report for each injury. Please print extra copies of this section if you want to report more than one injury. Please give this injury a name:

(eg: torn knee ligament)

Please identify all the parts of the body that were affected by this injury: gfedc Head

gfedc Neck

gfedc Shoulder

gfedc Back - please specify below

gfedc Arm/Hand

gfedc Hip

gfedc Leg

gfedc Foot

gfedc Internal organ, please specify below

gfedc Internal system (eg: nervous system), please specify below

gfedc Mental or emotional health, please specify below

Please tell us in your own words what happened and if applicable, which parts of the body were affected.

Was this a new injury or a recurrence of a pre-existing injury or condition?

nmlkj This was a new injury or condition

nmlkj This was a recurrence of a pre-exisiting injury or condition

Please select the options which best describe the circumstances surrounding the injury: (please tick as many options as appropriate) gfedc I was practising yoga at home or unsupervised by a yoga teacher

gfedc I was under supervision of a yoga teacher at the time

gfedc I followed a specific instruction from a yoga teacher (eg: directed at you)

gfedc I received a physical adjustment/correction from a yoga teacher

gfedc This injury required medical treatment or other similar intervention

gfedc This injury caused prolonged pain, discomfort or suffering

http://www.yogainaustralia.com/section6.php 12/10/2005 Yoga in Australia Survey - Section 6 Page 2 of 2

gfedc This injury resulted in time off work or other financial loss

Did this injury occur in the last 12 months?

nmlkj Yes nmlkj No

What style or lineage of yoga were you practising when this injury occurred (if known)?

Any further comments?

Are there any other comments you would like to make about this injury or yoga-related injuries in general?

http://www.yogainaustralia.com/section6.php 12/10/2005 Yoga in Australia Survey - Section 7 Page 1 of 2

SECTION 7. Subjective experience in yoga (Flow)

Please answer the following questions in relation to your experience in yoga. These questions relate to the thoughts and feelings you may experience during participation in yoga. You may experience these characteristics some of the time, all of the time, or none of the time. There are no right or wrong answers. Think about how often you experience each characteristic during yoga and tick the option that best matches your experience.

Please note: This is a standardised set of questions about "Flow" in different physical activities to allow for comparison. Some themes in the questions are intentionally repeated.

If you have not practised the physical aspects of yoga (eg: you have practised meditation only), this section is not for you. Please tick this box and leave the rest of the section blank: gfedc I have not practised the physical aspects of yoga.

When participating in yoga: Never Rarely Sometimes Frequently Always

1. I am challenged, but believe my skills will nmlkj nmlkj nmlkj nmlkj nmlkj allow me to meet the challenge 2. I make the correct movements without nmlkj nmlkj nmlkj nmlkj nmlkj thinking about trying to do so 3. I know clearly what I want to do nmlkj nmlkj nmlkj nmlkj nmlkj 4. It is really clear to me how my practice is going nmlkj nmlkj nmlkj nmlkj nmlkj

5. My attention is focused entirely on what I am doing nmlkj nmlkj nmlkj nmlkj nmlkj

6. I have a sense of control over what I am doing nmlkj nmlkj nmlkj nmlkj nmlkj

7. I am not concerned with what others may be thinking of me nmlkj nmlkj nmlkj nmlkj nmlkj

8. Time seems to alter (either slows down or speeds up) nmlkj nmlkj nmlkj nmlkj nmlkj

9. I really enjoy the experience nmlkj nmlkj nmlkj nmlkj nmlkj

10. My abilities match the high challenge of the situation nmlkj nmlkj nmlkj nmlkj nmlkj

Never Rarely Sometimes Frequently Always

11. Things just seem to happen automatically nmlkj nmlkj nmlkj nmlkj nmlkj

12. I have a strong sense of what I want to nmlkj nmlkj nmlkj nmlkj nmlkj do 13. I am aware of how well I am practising nmlkj nmlkj nmlkj nmlkj nmlkj

14. It is no effort to keep my mind on what is happening nmlkj nmlkj nmlkj nmlkj nmlkj

15. I feel like I can control what I am doing nmlkj nmlkj nmlkj nmlkj nmlkj

16. I am not concerned with how others may be evaluating me nmlkj nmlkj nmlkj nmlkj nmlkj

17. The way time passes seems to be nmlkj nmlkj nmlkj nmlkj nmlkj different from normal

http://www.yogainaustralia.com/section7.php 12/10/2005 Yoga in Australia Survey - Section 7 Page 2 of 2

18. I love the feeling of the practice and want nmlkj nmlkj nmlkj nmlkj nmlkj to capture it again 19. I feel I am competent enough to meet the nmlkj nmlkj nmlkj nmlkj nmlkj high demands of the situation 20. I practice automatically, without thinking nmlkj nmlkj nmlkj nmlkj nmlkj too much

Never Rarely Sometimes Frequently Always

21. I know what I want to achieve nmlkj nmlkj nmlkj nmlkj nmlkj

22. I have a good idea while I am practising nmlkj nmlkj nmlkj nmlkj nmlkj about how well I am doing 23. I have total concentration nmlkj nmlkj nmlkj nmlkj nmlkj

24. I have a feeling of total control nmlkj nmlkj nmlkj nmlkj nmlkj

25. I am not concerned with how I am presenting myself nmlkj nmlkj nmlkj nmlkj nmlkj

26. It feels like time goes by quickly nmlkj nmlkj nmlkj nmlkj nmlkj

27. The experience leaves me feeling great nmlkj nmlkj nmlkj nmlkj nmlkj

28. The challenge and my skills are at an equally high level nmlkj nmlkj nmlkj nmlkj nmlkj

29. I do things spontaneously and nmlkj nmlkj nmlkj nmlkj nmlkj automatically without having to think 30. My goals are clearly defined nmlkj nmlkj nmlkj nmlkj nmlkj

Never Rarely Sometimes Frequently Always

31. I can tell by the way I am practising how well I am doing nmlkj nmlkj nmlkj nmlkj nmlkj

32. I am completely focused on the task at hand nmlkj nmlkj nmlkj nmlkj nmlkj

33. I feel in total control of my body nmlkj nmlkj nmlkj nmlkj nmlkj

34. I am not worried about what others may be thinking of me nmlkj nmlkj nmlkj nmlkj nmlkj

35. I lose my normal awareness of time nmlkj nmlkj nmlkj nmlkj nmlkj

36. The experience is extremely rewarding nmlkj nmlkj nmlkj nmlkj nmlkj

This scale was developed and validated in physical activity settings by Dr Susan Jackson, currently a Senior Research Fellow at the University of Queensland. Dr Jackson has an on-going research program involving the investigation of flow state across different activities, and she has a particular interest in understanding the connection between yoga and flow.

http://www.yogainaustralia.com/section7.php 12/10/2005 Yoga in Australia Survey - Section 8 Page 1 of 1

SECTION 8. Plain Language Statement and Privacy Policy about your privacy and how we protect it

Survey Information

Who is conducting the survey and why? The Yoga in Australia survey is being conducted by researchers at RMIT University. The survey will provide important information about the way in which yoga is being practised in Australia today; the styles and traditions being practised, the socio-economic characteristics of people who practice yoga, the exercise co-factors, health outcomes and the injury rates, amongst other things.

Confidentiality and security of the data. All survey data collected on the website is strictly confidential. Only pooled responses will be reported in survey results so that individuals cannot be identified. Information collected from the survey will be kept on a password-protected computer (accessible only to the researchers) for a period of 8 years before being destroyed in accordance with RMIT protocol.

Your participation and consent. Your participation in this survey is voluntary. Your consent to use your survey data is implied by your completion of the survey. The survey should take 20-30 minutes depending on which sections you complete.

How can I get a copy of the results? By providing your email address (opt-in), you give us permssion to send you (by email), survey news updates and a complimentary copy of the survey results when they are made available. If you do not do this, we will not contact you at all. You can also "out-out" at any time using any of the response forms on the website.

Where will the results be published? It is expected that the survey results will be published in professional journals and yoga magazines. Due to the public interest in the survey, the results will also be reported in the mainstream media.

Other Uses of Personal Information Any personal information (eg: your name, address or email address) you provide us with is strictly confidential and will never be disclosed to a third party unless we are required to do so by law. You can also request a copy of, and make changes to, your personal information at any time.

Changes to this Policy From time to time, we may make changes to this Plain Language Statement and Privacy Policy and will post those changes on the website. If you have any questions or concerns about your privacy, please contact us using the details below.

Yoga in Australia Survey PO Box 208 West Brunswick VIC 3055 Phone/Fax: (03) 9445 9038 Email: click here

This survey has been approved by the Human Research Ethics Committee at RMIT University. Any complaints about your participation in this study may be directed to The Secretary, Human Research Ethics Committee, RMIT, 124 La Trobe St, Melbourne, 3000.

http://www.yogainaustralia.com/section8.php 13/10/2005 Tell a Friend Send an invitation postcard (e-card) to a friend (or group of friends) with one easy form.

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Subject: Check out the World Yoga Survey

Message: Hi, send this e-card to your friends I'm sending you this note from the World Yoga Survey (click to view actual size) website.

In case you haven't already heard, researchers from universities around the world are conducting the first-ever world survey of yoga and meditation. This is a major event for the yoga community so I thought you would want to be part of it. Opt-in / Keep me informed Don't contact me Opt-out: Subscribe here to receive survey updates by email. Your email address is kept strictly private and will not be used for any other purpose. Your friend's email address/es are only used to send this email and are not retained by our system. You can opt-out at any time by changing your preferences. Read our plain language privacy policy here.

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Your personal invitation, along with a postcard, will help us achieve a strong response from the yoga public. Please help make our first national yoga survey a great success!

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Why do I have to register? Firstly, you need to choose a Username and Password and enter your email address to create an account. When you do this, we will automatically send a validation email to your email address. You must click the link in the email we send you before you can access the survey pages. This only takes a minute and helps to protect the integrity of the data. Once you have done this, you are free to login or logout from the survey as you please. You can complete some pages now, some later. Each time you login, your previous answers will be displayed so you can make changes if you like. Please remember to click "submit" for the page you are working on before you logout so your answers are saved.

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http://www.yogasurvey.com/survey/help.php 3/02/2008

Front and back of promotional postcard

Last Update: 17 May 2007 - 12:39 Update now

Reported period: - Year - 2005 OK

Summary Reported Year 2005 period First visit 07 Aug 2005 - 05:53 Last visit 31 Dec 2005 - 23:58 Unique visitors Number of visits Pages Hits Bandwidth <= 10582 Exact value not 16163 117255 1006981 8.14 GB Traffic viewed * available in 'Year' (1.52 visits/visitor) (7.25 pages/visit) (62.3 hits/visit) (528.18 KB/visit) view Traffic not 11272 14014 991.50 MB viewed * * Not viewed traffic includes traffic generated by robots, worms, or replies with special HTTP status codes.

Monthly history

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

2005 2005 2005 2005 2005 2005 2005 2005 2005 2005 2005 2005

Unique Number of Month Pages Hits Bandwidth visitors visits Jan 2005 00000 Feb 2005 00000 Mar 2005 00000 Apr 2005 00000 May 2005 00000 Jun 2005 00000 Jul 200500000 Aug 2005 1977 3112 21921 228934 1.94 GB Sep 2005 2379 3642 27564 278777 2.05 GB Oct 2005 2224 3380 26550 227946 1.83 GB Nov 2005 2338 3544 22462 190072 1.51 GB Dec 2005 1664 2485 18758 81252 817.79 MB Total 10582 16163 117255 1006981 8.14 GB

Days of month

01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Av Dec Dec Dec Dec Dec Dec Dec Dec Dec Dec Dec Dec Dec Dec Dec Dec Dec Dec Dec Dec Dec Dec Dec Dec Dec Dec Dec Dec Dec Dec Dec

Number of Last Update: 17 May 2007 - 12:39 Update now

Reported period: - Year - 2006 OK

Summary Reported Year 2006 period First visit 01 Jan 2006 - 00:03 Last visit 31 Dec 2006 - 23:47 Unique visitors Number of visits Pages Hits Bandwidth <= 7934 Exact value not 11521 46103 525560 5.12 GB Traffic viewed * available in 'Year' (1.45 visits/visitor) (4 pages/visit) (45.61 hits/visit) (465.82 KB/visit) view Traffic not 30587 34330 1.24 GB viewed * * Not viewed traffic includes traffic generated by robots, worms, or replies with special HTTP status codes.

Monthly history

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

2006 2006 2006 2006 2006 2006 2006 2006 2006 2006 2006 2006

Unique Number of Month Pages Hits Bandwidth visitors visits Jan 2006 885 1394 7022 95428 743.32 MB Feb 2006 857 1178 9381 88435 565.48 MB Mar 2006 1015 1371 7039 103922 888.32 MB Apr 2006 1190 1580 3503 72601 769.08 MB May 2006 638 910 2273 26988 349.37 MB Jun 2006 468 709 2383 22262 330.32 MB Jul 2006 527 798 2300 19329 291.95 MB Aug 2006 545 847 2227 18758 277.71 MB Sep 2006 480 689 2049 17022 242.29 MB Oct 2006 465 702 3557 27301 313.19 MB Nov 2006 440 694 1618 18309 259.20 MB Dec 2006 424 649 2751 15205 210.79 MB Total 7934 11521 46103 525560 5.12 GB

Days of month

Number of

Last Update: 18 Feb 2008 - 08:43 Update now

Reported period: - Year - 2007 OK

Summary Reported Year 2007 period First visit 01 Jan 2007 - 00:09 Last visit 31 Dec 2007 - 23:13 Unique visitors Number of visits Pages Hits Bandwidth <= 5970 Exact value not 8536 24235 188827 2.96 GB Traffic viewed * available in 'Year' (1.42 visits/visitor) (2.83 Pages/Visit) (22.12 Hits/Visit) (363.01 KB/Visit) view Traffic not 28649 29112 1.02 GB viewed * * Not viewed traffic includes traffic generated by robots, worms, or replies with special HTTP status codes.

Monthly history

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

2007 2007 2007 2007 2007 2007 2007 2007 2007 2007 2007 2007

Unique Number of Month Pages Hits Bandwidth visitors visits Jan 2007 485 815 3284 17465 258.43 MB Feb 2007 431 626 2758 17125 229.96 MB Mar 2007 499 776 2795 19468 302.31 MB Apr 2007 396 574 2312 13133 206.26 MB May 2007 546 777 1609 15802 260.61 MB Jun 2007 491 723 1519 13700 224.66 MB Jul 2007 523 769 1721 16035 259.17 MB Aug 2007 533 731 1757 14338 243.34 MB Sep 2007 517 691 1755 17327 279.89 MB Oct 2007 551 720 1595 16102 273.07 MB Nov 2007 516 668 1621 15364 262.07 MB Dec 2007 482 666 1509 12968 226.33 MB Total 5970 8536 24235 188827 2.96 GB

Days of month media release

NEWS EVENTS RESEARCH EXPERT COMMENTS NEWS EVENTS RESEARCH EXPERT COMMENTS

21 June 2005

RMIT conducts first national yoga survey

RMIT University researchers will conduct the first ever national yoga survey to examine the practice of yoga as a physical activity, a therapy and a lifestyle or spiritual path, as well as determining the economic impact of yoga and the extent of yoga-related injuries.

While yoga seems to be extremely popular in Australia, with Australian Bureau of Statistics data suggesting that more Australians turn to yoga for exercise than Australian Rules football, researchers Professor Marc Cohen and Stephen Penman are determined to lift the lid on the sort of yoga practices Australians favour and why.

The researchers are confident that the RMIT study is the first yoga survey of its type in the world.

“This survey breaks new ground as it is being conducted on the internet using the latest web-based technology to reach thousands of yoga enthusiasts across Australia,” said Mr Penman, a yoga teacher experienced in web-based data collection.

Professor Cohen, Head of Complementary Medicine at RMIT, said yoga was also becoming “well accepted by the medical profession as part of an integrative approach to health care”.

“It is often for exercise or health reasons that people first come to experience yoga, however some people may continue to practice yoga as a path to inner peace and happiness. The reasons people commence or continue to practice yoga have never been assessed,” he said.

The Yoga in Australia survey is open to anyone who has ever practiced yoga, including yoga teachers and students, regardless of their level or frequency of practice. The survey can be found at www.yogainaustralia.com

Media enquiries: Professor Marc Cohen: (03) 9925 7440 or 0439 446 688 Stephen Penman: (03) 9354 6821 or 0438 004 807

For more information, contact: RMIT Media and Communications (03) 9925 2807.

MELBOURNE CBD BUNDOORA BRUNSWICK HAMILTON EAST GIPPSLAND VIETNAM Australian Yoga Life Advertising

Nov 04 Mar 05

Jul 05

Nov 05

Mar 06 28 health and healing Tuning into the planet with yoga and meditation

spiritual interaction and education[6]. PROFESSOR MARC COHEN Whether we are clinically ill or in average AND STEPHEN PENMAN health, the application of yoga lifestyle increases our ‘flexibility of response’ to y virtue of its holistic philosophy, further enhance health at every point in yoga offers many health-enhancing the spectrum of health. Btechniques which have often been singled out and practised in isolation from Meditation is part of yoga the “whole-istic” spiritual path of yoga. In Yoga includes the mental discipline of the west, yoga postures are commonly used meditation which offers profound as a physical activity while specific yoga physiological and psychological benefits. techniques are sometimes used for their YOGA. SCHOOL OF INTERNATIONAL AND GITA Whether focussing on a single thought, health benefits as a therapy. Very often it is object or mantra (dharana) or de-focussing for these reasons that people first come to to achieve a thought-less state (dhyana), experience “yoga”. However, some people meditation is an integral part of the yoga progress to a deeper understanding and 2005 CALENDAR. OF SHELLEY FLADGATE IMAGES COURTESY path to enlightenment, or self-realisation. PHOTO APPEARS IN THE GITA INTERNATIONAL SCHOOL OF YOGA SCHOOL OF INTERNATIONAL THE GITA APPEARS IN PHOTO practice of yoga as a path to enhanced Anytime you are involved in an activity health and enlightenment, bringing that totally absorbs your awareness so that freedom from disease, repetitive thoughts you seem to ‘lose yourself in the moment’, and behaviours and a lasting sense of inner you can consider that activity to be akin peace and happiness, despite the stresses have been shown to be effective to pro- database, in June 2004 and found consider- to meditation. and strains of modern life. mote health and treat disease. In the now able recent research into yoga for stress, While there are many different systems Yoga has its roots in the ancient Hindu classic book, Light on Yoga[2], BKS Iyengar high blood pressure, heart disease, asthma, of meditation and different philosophies healing science known as Ayurveda. The lists “curative asanas for various diseases”. depression, carpal tunnel syndrome, dia- that accompany them, any single-minded term ‘yoga’ is derived from the Sanskrit Detailed postures and yogic practices are betes, epilepsy and back pain. In just one endeavour may be considered a medita- term ‘yuj’ meaning ‘joining’, or ‘that which listed for some 88 diseases or health example, the now famous Dean Ornish tion. Any time you are involved in an joins’. In the traditional terminology it is conditions, illustrating that in yogic philos- Lifestyle Heart Trial[4,5] found that intensive activity that totally absorbs your awareness the joining of jivatma, the individual self ophy, practices such as kriya (cleansing), lifestyle change based around the principles so that you seem to ‘lose yourself in the or consciousness, with paramatma, the pranayama (breathing), asana (postures) of integral yoga could reverse heart disease. moment’ you can consider that activity to universal consciousness, through a system and meditation have long been used in the The Ornish program consisted of a low fat be akin to meditation. During such an of development which addresses the physi- treatment of illness. Some of the conditions vegetarian diet, three hours per week exer- activity it is common to not only lose your cal, mental, emotional, intellectual, and for which Iyengar prescribes yogic practices cise, stress management activities including sense of self, but to also lose your sense of spiritual layers of the personality[1]. are arthritis, asthma, back pain, high blood relaxation meditation, breathing exercises, time. These activities, which are in line pressure, bronchial disorders, epilepsy, dia- and guided imagery, as well as twice weekly with the yogic practice of dispassionate Yoga for enhanced health betes, coronary artery disease and sciatica. group support meetings. This lifestyle awareness, seem to enhance the overall While the ultimate goal of yoga is ‘union’ To test this from a western medical approach can be described as the ‘SENSE’ experience of life when included as part of or self-realisation, there are many yoga perspective, we did a ‘keyword search’ of approach to health which includes stress a daily routine. practices, even taken in isolation that that Pubmed[3], an online medical research management, exercise, nutrition, social and As well as having psychological benefits,

australian college of classical yoga

Wisdom training in Yoga Yoga teacher training Certificate of Classical Yoga Diploma of Classical Yoga Yoga Sutras and Meditation – Primary course qualifies you to learn to teach the wisdom philoso- teach after one year phy of Yoga - no asana included. Current yoga teachers may also Certificate of Asana & Anatomy take this to learn about the Yoga Catch up on the anatomy you Sutras missed – all put in the context of Asana Certificate of Stillness Meditation Learn to assist others to a state of Advanced Dip Classical Yoga, stillness of mind, the root of all seri- Master of Classical Yoga ous spiritual practice Enquire about prerequisites and syllabus www.classicalyoga.com.au • 32 Jenner St Blackburn South Enquiries: [email protected] • Ph (03) 9833 4050 <> livingnow.com.au April 2005 health and healing 29 PHOTO APPEARS IN THE GITA INTERNATIONAL SCHOOL OF YOGA 05CLNA.IMAGES COURTESY OF SHELLEY FLADGATE 2005 CALENDAR. the practice of meditation initiates pre- a hammer strikes a bell. When a hammer dictable and reproducible changes in physi- strikes an unfashioned piece of metal, the ological functioning. These include a resulting clang contains many different reduction in heart rate, blood pressure, frequencies that dissipate rather quickly. AND GITA INTERNATIONAL SCHOOL OF YOGA. oxygen consumption and stress However, if the metal sheet is fashioned hormones[7,8]. There are also distinctive EEG into the shape of a bell, particular frequen- changes associated with meditation and cies will naturally resonate with the shape these include a greater coherence and of the structure producing a characteristic synchrony across the brain and a tendency sound. This distinctive tone is made up of for increased activity in the alpha/theta distinct resonant frequencies that may frequencies (around 8 hertz) [9,10]. This reverberate for some time. altered EEG activity results in the brain It is interesting to speculate that during adopting similar frequencies to the electro- meditation the brain appears to harmonise magnetic frequencies that occur around with planetary electromagnetic activity. the planet called Schumann resonances. It is interesting to speculate that during meditation the brain appears to harmonise Tuning into the planet with planetary electromagnetic activity. Schumann resonances are naturally The correlation between planetary and occurring electromagnetic waves that travel cerebral electromagnetic activity, however, freely around the planet as a result of must be noted merely as an association global lightning. They are named after because it is almost impossible to prove a Professor W.O. Schumann who proposed causal connection between the two. This the existence of such waves and calculated association becomes even more interesting their main frequency[11]. These resonances when it is realised that the vast majority of occur in the non-conducting cavity global lightning is concentrated over the between the relatively conducting bound- three main rainforest areas of the planet. aries formed by the ionosphere (which These areas, located in Southeast Asia, sub- forms the upper atmosphere above around Sahara Africa and the Amazon basin, tend 50 kilometers) and the surface of the earth to have thunderstorm activity in the late consisting mainly of seawater. afternoon and, as they are distributed fairly Lightning discharges within the earth- evenly around the globe, maintain a con- ionosphere cavity produce electromagnetic stant level of lightning activity that in turn, radiation of many different frequencies, maintains the global Schumann most of which rapidly dissipate as they Resonance[13]. It is therefore possible that spread away from the source. Those when we meditate we have a subconscious frequencies that correspond to wavelengths connection to the greatest life force on the of similar dimensions to the circumference planet – the planetary rainforests. of the earth, however, are able to propagate Meditation seems to have a homeostatic several times around the planet before effect on the body and on consciousness. undergoing significant attenuation. As By finding a still point in consciousness there are approximately 100 lightning other extraneous thoughts are expelled and strikes per second on the planet, there are the mind gets a chance to free itself from many such waves undergoing phase addi- mundane concerns. After meditation the tion and cancellation resulting in an inco- mind gains a renewed sense of focus and herent superposition of waves producing a perspective. Finding that still point in frequency spectra known as Schumann consciousness enables us to obtain the resonances. These resonances have been most mental flexibility, just as our found to occur at 8, 14, 20, 26, 32, 38 Hz flexibility of response increases as with the principle component at around well-being is enhanced. 8 Hz[12]. The production of Schumann resonance may be likened to the tone produced when ✎ continued on page 30

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Market: NSW Date: Sunday, 26 June 2005 Circulation: 726,238 Page Number: 35 Published: WEEKLY Size: 104.30 sq. cm. Edition: FIRST Editorial: email the editor Supplement: main Item No: P6545702 ______

Study into yoga’s benefits By SHARON LABI 85 per cent of them women, regularly practise yoga, either for THE many thousands of exercise, to improve posture and Australians who practise yoga breathing techniques, for relaxation probably have little idea how much or for spiritual reasons. benefit, if any, that it provides. Leigh Blashki, director of the Researchers at RMIT University Australian Institute of Yoga now plan to find out. Therapy, said 45 different types of In the first national yoga survey, yoga were practised in Australia. the university’s head of He said government-accredited complementary medicine, Professor training courses and support from Marc Cohen, will examine why the medical fraternity had led to a people do yoga, which lineage they boom in the industry. practise, how much it costs, and RMIT has written to 1000 yoga whether they suffer any injuries. schools, associations and businesses Prof Cohen, who will conduct the asking those who take part in yoga study with yoga teacher Stephen to fill out an on-line survey at Penman, said despite the popularity www.yogainaustralia.com.au of yoga, there was no It has taken measures to ensure comprehensive data available. respondents do not make Popular: A yoga class It is believed about 300,000 people, multiple replies.

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Yoga teachers at a stretch as

scramble for students hots up ByDAKIELLETEUTSCH

SYDNEY’S "If someone opens next to your boomers are a key market booming yoga market is up school and takes all your students But the most yoga becoming increasingly cutthroat as rapidly growing studios has seven woo students with unashamedly you’re not going to be happy about it "brand is Bikram’s which Western he said "There are so studios in and is pitched as a edly marketing techniques only many Sydney and class schools an area can support gym-like workout prices top the $20 mark In Bondi Mr Grant said casual class prices In a unyogic move Bikram’s alone there are seven voga very who is studios for had crept from about $12 five years founder Bikram Choudhury vying students including up the to more than $20 with schools based in Los Angeles settled global juggernaut Bikram’s Yoga ago recently court challenge to his attempt to College of India offering gym-like memberships in an a copyright his series of 26 postures Such is effort to win yoga’s popularity that Australian loyalty tralian "It’s too expensive for some Almost as entrepreneurialas Bikram Bureau of Statistics figures already Baron Baptiste show it is people to practise he said is fellow American practisedby 2 per cent of energetic "hot yoga the Liotta owner of Yoga Mat in whose similar population making it more popular Frances style Power Vinyasa Yoga is famed for lar than Australian football Bondi said there was no doubt that was more competitive its "boot camps for devotees Competition in the eastern suburbs yoga getting yoga owner Nicole is she said there was still mutual BodyMindLife so intense that a studio owner placed though Walsh denied the was cutthroat a respect teachers industry ban later lifted on her trainee among combination throat or that there was teachers business is a any attending classes at a rival "Yoga and funny competition and yet backstabbing "We respect each other’s studio set up by a former student bination There’s compe- business and livelihood she said supposed to be Some schools have also introduced there’s not There are no figures on the size of their own line of DVDs and tition There’s jealousy and yet there’s clothing "Yoga Inc in Australia though RMIT expensive teacher courses not supposed to be jealousy But we are training University’s professorof complementary that prevent students from human she said teaching medicine Marc Cohen will begin conducting a that the school’s trademark style elsewhere In sign yoga has become the a national this month aerobics of the noughties the former ducting survey Alex Grant who runs the website But Professor Cohen said that ultimately owner of Healthlands gym in Bondi findyoga said there were at least the commercialisationof yoga in Junction Richard Chew has started mately 100 yoga schools in not including Sydney Australia didn’t matter if it encouraged the Elix’r Mind Health Club the number of companies such as Body ing more people to do it "We’ve got a chain which specialises in yoga big law firm Minter Ellison that offer inhouse mainstream epidemic of obesity diabetes and "I believe yoga has gone house classes He said he was aware of arthritis he said stream Mr Chew said "The baby some infighting between teachers

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RESPECT’ WE SHOW Nicole Walsh assists a student at the BodyMindLife yoga studio in Surry Hills

CASUAL CLASS COSTS

Õ Elix’r Mind Body Health Club City ...... $25 Õ BikramYoga ...... $17 Õ Bondi Beach lyengar Yoga Institute ...... $17

Õ Bondi Bliss ...... $20

Õ BodyMindLife Surry Hills ...... $18 Õ North Sydney Yoga .... $18

Õ Ki Yoga Bondi Beach ... $14 Õ DharmaShala Bondi Yoga School ...... $15

Õ Yoga Mat Bondi Junction ...... $16 Õ Yoga Synergy ...... $16

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Why yoga’s in vogue

NO THIS isn’t the latest Village People tribute band busting out some YMCA moves RMIT’s Stephen Penman (front and Professor Marc Cohen are conducting a web-based national survey to learn more about yoga practices in Australia "We know that yoga has become extremely popular lar in the but West we aren’t really sure why people start and continue it

Cohen said "This study will determine how often it is used for treatment exercise as a way of life or a spiritual path as well as the benefits and risks Anyone in Australiawho has taken part in yoga can take the survey the over next five months by visiting www The results will be published on the website by the end of the year

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Breathe, stretch - and now for the rugby prop pose - National - smh.com.au Page 1 of 2

Breathe, stretch - and now for the rugby prop pose By Steve Meacham September 12, 2005

No limit … Troy Green, a fireman and former rugby player, finds power yoga suits "big, heavy guys" who believe more traditional styles are too soft for them. Photo: Jon Reid

Rugby prop forwards in a yoga class? It's happening across the city as yoga no longer remains the domain of women or guru types. Duncan Peak, a former parachute officer turned yoga teacher, is an Australian pioneer of a new form of yoga attracting many men. Power yoga, or vinyasa, was developed in the 1990s by an American, Baron Baptiste, whose client list includes the Philadelphia Eagles gridiron team. But it has only recently arrived in Sydney. The Australian Bureau of Statistics says 85 per cent of yoga pupils are women, but Mr Peak said at least a third of his power yoga pupils at the Body Mind Life gym in Neutral Bay were men. "We get a lot of guys who have pumped weights … who come here to nurse their old injuries or reclaim the flexibility they used to have," Mr Peak said. "Guys can relate to it a lot more. It's very intense, one of the hardest workouts anyone can experience. But the relaxed state you feel afterwards is quite foreign to a lot of guys who have been used to the gym all their lives and never looked at holistic exercise." Troy Green, 33, a fireman, former prop forward and keen bodybuilder who weighs 100 kilograms, said: "I tried yoga before but didn't really get into it." What he liked was that so many of his new classmates were "big, heavy guys", he said. And what he enjoyed most was the feeling afterwards. "It honestly makes me feel like waving at strangers. It's just like having a good surf." Stephen Penman, co-author of a study by RMIT University into yoga in Australia, said power yoga was one of several styles helping to convert men to yoga as a sport. "Some styles of yoga attract men more than others, particularly the more aerobic, physical forms. Guys hardly turn up at all for the classical, more gentle styles." But Moina Bower, president of the Sydney-based International Yoga Teachers Association, disagreed. She has noticed a rise in male pupils in her more traditional classes. "Ten years ago it

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used to be 10 per cent; now it's about 25 per cent." Many of her male pupils were businessmen looking for something to relieve stress, not something involving "performance anxiety", she said. Everyone's getting the Herald home delivered. Weekends for only $3 a week.