Dr Jennifer Flaim DO Yoga Medicine YTT 200 What is Yoga? A group of physical, mental, and spiritual practices which originated in ancient India.
Yoga comes from the Sanskrit word yuj, meaning to yoke or unite. Yoga is the union of mind, body, and spirit. Perception
The Eight Limbs of Yoga Yama- Universal Morality Niyama- Personal observances Asana- physical postures Pranayama- Breathing exercises Pratyahara- Control of the senses Dharana- Concentration and cultivating inner perceptualawareness. Dhyana- Devotion, Meditation on the divine Samadhi- Union with the Divine Asana- the postures/poses.
Yoga’s Physical benefits Rest Proprioception/Balance Increased Flexibility Cadiovascular/Circulatory Strength/Endurance health Weight reduction Improved Athletic performance Alignment REST Postural awareness Pranayama – the Breath What is it? Formal practice of controlling the breath (prana or lifeforce).
The respiratory system is one of the few internal regulatory systems of the body that we can consciously control.
Breath rate directly affects the vagus nerve, which is central to the nervous system response. Pranayama- Breathing During the stress response, the sympathetic nervous system is triggered resulting in increased heart rate/BP, shunting of blood to skeletal muscle, stress hormone production/release, increased blood glucose, increased inflammatory cytokines, etc, etc, etc.
However, humans have the capability of initiating the opposite response with the use of behavioral strategies including meditation and slow intentional breathing.
When the relaxation response is initiated we see opposing physiological changes to the stress response. Sengupta P. Health Impacts of Yoga and Pranayama: A State-of-the- Art Review. Int J Prev Med. 2012;3(7):444–458. Yoga and the Relaxation Response
Sengupta P. Health Impacts of Yoga and Pranayama: A State-of-the-Art Review. Int J Prev Med. 2012;3(7):444–458. Meditation A practice including a variety of techniques (such as mindfulness or focus on a particular object, phrase, thought, or activity) to train attention and awareness, and achieve mental clarity and a calm and stable emotional state.
Meditation techniques can include Focus on the breath (1:1, 1:2, 1:1:1 breathing) Mantra Mindful meditation Visualization Walking meditation Meditation and Pain •Brain activations and deactivations associated with the main effect of pain in each group in MRI Session. •Group comparisons revealed significantly greater activation in the left DLPFC in the placebo, sham mindfulness meditation, and control group compared with the mindfulness meditation group.
•These findings demonstrate that mindfulness meditation reduces pain through unique mechanisms and may foster greater acceptance of meditation as an adjunct pain therapy.
Mindfulness Meditation-Based Pain Relief Employs Different Neural Mechanisms Than Placebo and Sham Mindfulness Meditation-Induced Analgesia Fadel Zeidan, Nichole M. Emerson, Suzan R. Farris, Jenna N. Ray, Youngkyoo Jung, John G.McHaffie, Robert C. Coghill Journal of Neuroscience 18 November 2015, 35 (46) 15307- 15325; DOI:10.1523/JNEUROSCI.2542-15.2015 Yoga and the Relaxation response
Upregulated pathways induced by RR linked to energy production in mitochondria, linked to telomerase stability and maintenance.
Progressive and longterm downregulated pathways induced by RR induced alteration of NF-κB-dependent pathways( inflammation).
•This study demonstrates that during one session of RR practice rapid changes in gene expression (on the order of minutes) are induced that are linked to a select set of biological pathways among both long-term and short-term practitioners that might explain the health benefits of RR practices.
Bhasin MK, Dusek JA, Chang BH, et al. Relaxation response induces temporal transcriptome changes in energy metabolism, insulin secretion and inflammatory pathways [published correction appears in PLoS One. 2017 Feb 21;12 (2):e0172873]. PLoS One. 2013;8(5):e62817. Published 2013 May 1. doi:10.1371/journal.pone.0062817 Yoga in Breast Cancer
Bower, J. E., Garet, D. , Sternlieb, B. , Ganz, P. A., Irwin, M. R., Olmstead, R. and Greendale, G. (2012), Yoga for persistent fatigue in breast cancer survivors. Cancer, 118: 3766-3775. doi:10.1002/cncr.26702
Yoga and Breast Cancer Metastatic breast cancer remains a terminal illness for which major treatment advances are slow to appear. Effective palliative interventions need to be developed to reduce the cancer-related symptoms of women with this condition during the remaining years of their lives.
The eight-week protocol included gentle yoga postures, breathing exercises, meditation, didactic presentations, and group interchange. Outcome was assessed using daily measures of pain, fatigue, distress, invigoration, acceptance, and relaxation during two pre-intervention weeks and the final two weeks of the intervention.
Lagged analyses of length of home yoga practice showed that on the day after a day during which women practiced more, they experienced significantly lower levels of pain and fatigue, and higher levels of invigoration, acceptance, and relaxation.
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;33:331–41. Yoga and Mental Health
The 12-week yoga intervention was associated with greater improvements in mood and anxiety than a metabolically matched walking exercise. This is the first study to demonstrate that increased thalamic GABA levels are associated with improved mood and decreased anxiety. It is also the first time that a behavioral intervention (i.e., yoga postures) has been associated with a positive correlation between acute increases in thalamic GABA levels and improvements in mood and anxiety scales.
Streeter CC, Whitfield TH, Owen L, et al. Effects of yoga versus walking on mood, anxiety, and brain GABA levels: a randomized controlled MRS study. J Altern Complement Med. 2010;16(11):1145–1152. doi:10.1089/acm.2010.0007 Research limitations and difficulties Style of Yoga Scale used No standard sequence Quality of Teacher Duration Difficult to Blind Variation in Poses Self referral Other limbs of yoga Attention/Group Support Short term vs long term Adherence No standard Length of Small sample sizes Intervention Sample population Practice at Home vs class (typically white female, Outcome measured high SES) Adverse Events Surveys Finnish Ashtanga survey- 62% at least 1 yoga injury Australian- 3892, 79% never been injured. Most were minor US- less than 1% practitioners reported a yoga related adverse event Germany- 303 patients, 4% reported adverse events Cramer 2015 Systematic Review of RCT- the safety of yoga. 301 RCT (8,430 participants), 92 reported adverse events. “Yoga appears as safe as usual care and exercise” Not all Yoga is made the same Many styles of yoga Varying standards for teachers Styles of Yoga: Restorative Restorative: a meditative practice that uses props like blocks, straps, sandbags, bolsters, and blankets to encourage a passive release of mind and body tension. This style works to release deep tension passively, without active stretch. No active stretch 100% passive support. Passive release of tension Poses held from 5-10 min. Many props used. Styles of yoga: Yin A practice that focuses on stretching your connective tissues/fascia. Poses are held for 3-5 minutes each to cultivate active stretch in your connective tissues to increase strength and flexibility, improve joint mobility, improve posture, and release tension in the body. Active stretching. Focus on connective tissues Props used. Poses held 3-5 minutes. Styles of Yoga: Iyengar By paying close attention to anatomical details and the alignment of each posture, Iyengar Yoga is the practice of precision. Poses are held for long periods and often modified with props. This method is designed to systematically cultivate strength, flexibility, stability, and awareness, and can be therapeutic for specific conditions. B.K.S. Iyengar founded Iyengar Yoga. Styles of Yoga: Hatha A general category that includes most yoga styles. Used in a broad way and can be difficult to know what a particular Hatha class will be like. In general it is relatively gentle, slow, and good for beginners or students who prefer a more relaxed style with longer holds. How to Recommend a Yoga Teacher Look for types of Yoga: Hatha, Beginner, Gentle, Yin, Therapeutic, Restorative. Avoid: Hot, Bikram, Ashtanga, Power, Vinyasa. Find teacher that provide private sessions. Yoga Alliance accredited program www.yogaalliance.org Find a Yoga Therapist International Alliance of Yoga Therapists (IAYT) http://www.iayt.org/ RYT-200, ERYT-200, RYT-500, ERYT-500 Number denotes hours of training E denotes number of teaching hours Not all Yoga Teachers are made the same International Association of Yoga Therapists Educational Standard Minimums clients/students 35 hours Yoga Foundations: 120 hours Principles and skills for working with Yoga teaching and philosophy 35 hours groups 10 hours Yoga and the Mind 35 hours Framework for Health and Disease 50 Practicum 205 hours hours Providing Yoga Therapy 55 mentorship Biomedical and Psychological Foundations: hours plus 155 hours of practicum 155 hours delivery Anatomy and Physiology 90 hours Additional Biomedical Knowledge 15 Professional Practice 30 hours hours Ethical Principles 15 hours Psychology and Mental Health 30 hours Legal, regulatory and business issues Additional knowledge 10 hours pertaining to YT 5 hours Body and Mind Integration 10 hours Relationship with peers, mentors, clinicians, and organizaitons 5 hours Yoga Therapy Tools and Therapeutic skills Personal and Professional Development Yoga Therapy tools 60 hours and CE 5 hours Basic Principles of the Therapeutic relationship 35 hours Principles and Skills for educationg Questions your Patient Can Ask How strenuous will the workout be? How many poses are done in what period of time? The level of difficulty of the poses? How and where the teacher was trained? What kind of yoga the teacher does? Whether there is attention to specific physical problem? Whether meditation is included in the lesson? Do the teacher modify postures? Does the patient connect or identify with other people in the class? Thank you Namaste