Special Invited Article Yoga As a Therapeutic Intervention : a Bibliometric Analysis of Published Research Studies
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Indian J Physiol Pharmacol 2004; 48 (3) : 269–285 SPECIAL INVITED ARTICLE YOGA AS A THERAPEUTIC INTERVENTION : A BIBLIOMETRIC ANALYSIS OF PUBLISHED RESEARCH STUDIES SAT BIR S. KHALSA Division of Sleep Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School ( Received on May 8, 2004 ) Abstract : Although yoga is historically a spiritual discipline, it has also been used clinically as a therapeutic intervention. A bibliometric analysis on the biomedical journal literature involving research on the clinical application of yoga has revealed an increase in publication frequency over the past 3 decades with a substantial and growing use of randomized controlled trials. Types of medical conditions have included psychopathological (e.g. depression, anxiety), cardiovascular (e.g. hypertension, heart disease), respiratory (e.g. asthma), diabetes and a variety of others. A majority of this research has been conducted by Indian investigators and published in Indian journals, particularly yoga specialty journals, although recent trends indicate increasing contributions from investigators in the U.S. and England. Yoga therapy is a relatively novel and emerging clinical discipline within the broad category of mind-body medicine, whose growth is consistent with the burgeoning popularity of yoga in the West and the increasing worldwide use of alternative medicine. Key words : yoga meditation pranayama asana bibliometric mind-body medicine review INTRODUCTION the human individual with the universal and transcendent Existence” (1). These Yoga is a practical discipline practices are believed to have originated in incorporating a wide variety of practices early civilization on the Indian subcontinent whose goal is the development of a state of and have been practiced historically in India mental and physical health, well-being, and throughout East Asia. Yoga techniques inner harmony and ultimately “a union of include the practice of meditation, *Corresponding Address : Sat Bir S. Khalsa, Ph.D., Division of Sleep Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115 (U.S.A). Phone : (617) 732-7994, Fax : (240) 269-6205, Email : [email protected] Source of Support : Mentored Research Career Development Award (5K01AT000066) from the National Centre for Complementary and Alternative Medicine of the National Institutes of Health, U.S.A. 270 Khalsa Indian J Physiol Pharmacol 2004; 48(3) regulation of respiration with a variety of the implementation of these techniques as breathing exercises, and the practice of a a therapeutic intervention in a number of number of physical exercises and postures, disorders which have psychosomatic in which the focus is more on isometric components. Historically, this limited exercise and stretching than on aerobic application of yoga techniques for specific fitness. disorders is relatively recent compared to the ancient Vedic origins of yoga (10). A general feature of these practices is their Gharote (1987) has stated that “the capability of inducing a coordinated therapeutic aspect of yoga does not feature psychophysiological response, which is the in any of the traditional systems of self- antithesis of the stress response. This help, except in the yoga sutras of Patanjali “relaxation response” consists of a where we come across the word vyadhi generalized reduction in both cognitive and meaning ‘disease’ in the list of disturbing somatic arousal as observed in the modified factors of mind that are obstacles to activity of the hypothalamic pituitary axis liberation. ... although yoga therapy was not and the autonomic nervous system (2). a developed branch of yogic discipline as Bagchi and Wenger (3), in their early classic such, we do get a glimpse of the therapeutic yoga research study wrote, “...physiologically effects of the practices in some of the hatha Yogic meditation represents deep relaxation yoga literature such as the Hatha Yoga of the autonomic nervous system without Pradipika. However, advice is given here drowsiness or sleep and a type of cerebral within the context of practice; that is, how activity without highly accelerated to deal with the complaints that arise from electrophysiological manifestation but faulty practice” (11). In fact, since the probably with more or less insensibility to primary goal of yoga practice is spiritual some outside stimuli for a short or long development, beneficial medical consequences time.” A large number of subsequent of yoga practice can more precisely be research studies examining the effects of described as positive “side effects” (12). these techniques both in isolation and in combination have further confirmed these The first systematic medical application early results (4–9). Both short term and of yoga started in India in 1918 at the Yoga long-term practice of yoga techniques are Institute at Versova near Mumbai, the associated with reductions of basal cortisol precursor of the Yoga Institute at Santa and catecholamine secretion, a decrease in Cruz (13). This was soon followed by the sympathetic activity, with a corresponding clinical work at the Kaivalyadhama Yoga increase in parasympathetic activity, Institute in Lonavala under Swami reductions in metabolic rate and oxygen Kuvalyananda in the 1920’s (14, 15). consumption and salutary effects on Subsequently, yoga therapy has proliferated cognitive activity and cerebral in India with the establishment of yogic neurophysiology. hospitals and clinics, notably the Swami Vivekananda Yoga Research Institute near Not surprisingly, the capability to affect Bangalore (sVYASA), and the widespread psychophysiological functioning has led to application of yoga treatments by clinicians Indian J Physiol Pharmacol 2004; 48(3) Bibliometric Analysis of Yoga Research 271 and yoga institutes (15–17). This trend has well-being : psychophysical and spiritual. also spread internationally, with the Further, Yoga is a paradigmatic system of appearance of yoga therapy centers, the religious therapeutics – a path of healing inclusion of yoga programs in hospital that serves the purpose of religious cancer programs and affiliated alternative liberation. Among world traditions, classical medicine centers and the establishment of Yoga is a useful starting point for inquiry a new breed of clinicians called yoga into the relationship of medical and therapists, for which there are yoga therapy religious health because it connects the training programs and a society, the cultivation of physical and psychological International Association of Yoga Therapists health with spiritual well-being and (IAYT), based in the United States. There exemplifies the idea of religious liberation are now also several dozen books available as healing” (22). Anand (1991) has stated specifically on the topic of yoga therapy in this more simply: “The ultimate aim of general, and even on yoga therapy for medical sciences is the attainment of specific disorders (18, 19). optimum physical and mental health for the individual. The ultimate aim of yogic The application of yoga in such a limited practices is also the same, viz. physical and and strictly therapeutic manner has drawn mental well-being” (23). some criticism from proponents of yoga (14), given that yoga techniques are in fact part Research on the psychophysiological of an ancient and sacred spiritual tradition effects of yoga practice began with historically applied as a holistic lifestyle Kuvalyananda’s work in the 1920’s, and discipline (20). This concern has been there are a number of published reviews of further aggravated by the rapidly growing this basic research literature (4, 5, 7, 14, popularity of yoga in the west and its 24). Research on therapeutic applications of subsequent commercialization and yoga and meditation began more recently application as a trendy body slimming and (14), and although there are reviews of this fitness tool. “Postures are taught as ends in literature, many of these are restricted to themselves merely to heal an illness, reduce specific disorders (20, 25–27). Furthermore, stress, or look better. The fact that these a good deal of research has been published postures are a foundation for self-realization in yoga specialty journals such as Yoga is generally ignored. Yoga is often thought Mimamsa, which are not easily accessible of as calisthenics, epitomized by the and therefore not consistently reviewed or headstand, the lotus posture, or another cited. A previous bibliometric analysis has pretzel-like pose.” (21). However, from a examined publications up to 1986 on both broader perspective, both the healing of basic and clinical research on meditation, disease and spiritual endeavors share a yoga and related topics, and incorporated a common ground historically, in that many variety of article types including theoretical religious traditions incorporate a healing essays, case reports, reviews and abstracts component. This is perhaps especially true (28). The purpose of this bibliometric of yoga: “Classical yoga is a source of many analysis is to identify the current full extent specific concepts and practices that promote of the yoga therapy studies published in 272 Khalsa Indian J Physiol Pharmacol 2004; 48(3) research journals, including the specialty databases with the term “yoga” as a yoga publications, so as to provide an keyword. Also excluded are applied studies accurate survey of the best research of mindfulness meditation (Vipassana) or the published