Principles and Practice of Yoga in Health Care

Sat Bir Khalsa, Lorenzo Cohen, Timothy McCall, Shirley Telles

• Publisher: Handspring Publishing
• Year: 2016
• ISBN:
  9781912085194
• Edition: 1
• Topic: Medicina
• Subtopic: Medicina alternativa e complementare

The Principles and Practice of Yoga in Health Care is a professional-level textbook with contributions by multiple expert researchers and therapists in the field.

This book

• brings together the science and the practice of yoga therapy
• supports the emergence of yoga therapy as a credible profession
• comprehensively summarizes research findings and their practical implications for professionals who use yoga or refer patients for yoga practice
• includes chapter contributions by leading biomedical researchers of yoga
• reviews the scientific evidence base for yoga for a wide variety of medical conditions
• Provides brief contributions by expert yoga therapists describing practical implementation issues relevant to yoga for specific conditions.

The editors include three eminent yoga therapy researchers and one renowned practitioner in the field. They have brought together an experienced team of researchers and yoga therapist contributors.

SECTION 1

INTRODUCTION TO YOGA AND YOGA THERAPY

CHAPTER 1 Introduction to yoga in health care

Content and structure of this textbook

CHAPTER 2 History, philosophy, and practice of yoga

CHAPTER 3 History, philosophy, and practice of yoga therapy

CHAPTER 4 Research on the psychophysiology of yoga

Square steatite seal of an individual seated in yogic position with heels pressed together under the groin. An archaeological find from the Indus Valley Civilization (prior to c. 1,500 BCE) in the northwest Indian subcontinent. © JM Kenoyer/Harappa.com, courtesy of the Department of Archaeology and Museums, Government of Pakistan.

CHAPTER ONE

INTRODUCTION TO YOGA IN HEALTH CARE

SBS KHALSA • S TELLES • L COHEN • T MCCALL

The need for this textbook has arisen for a number of reasons. One is the remarkable growth in popularity of yoga practice among the general public. Yoga is found on every continent, in urban and rural areas, in health clubs, yoga studios, church basements, public parks, retirement homes, military bases, high school gymnasiums, corporate boardrooms, and on the wards of major teaching hospitals. In countries where multiple surveys have been conducted over time, the percentage of the population actively practicing yoga is increasing (Ding & Stamatakis, 2014), with US figures growing from 5.1% in 2002 to 6.1% in 2007 to 9.5% in 2012 (Clarke, Black, Stussman, Barnes, & Nahin, 2015). The increase in popularity by 50% in the 5-year span from 2005 to 2012 suggests that this is not a steady linear increase, but rather an exponential one, and it is likely that sometime soon, 15% of the population will be practicing yoga. Indeed, the 2016 Yoga in America Study commissioned by Yoga Journal and Yoga Alliance estimated that the number of people practicing yoga in the US is more than 36 million, compared to 20.4 million in 2012. Furthermore, more than one-third of non-practitioners surveyed said they were “somewhat” or “very likely” to practice yoga in the next 12 months, suggesting that 80 million are likely to try yoga in 2016 (http://www.yogajournal.com/yogainamericastudy/). Arguably, yoga has become an integral part of modern society with no signs of diminishing popularity. Examples of yoga’s widespread cultural influence include the proclamation by the United Nations General Assembly in 2014 of June 21 as the annual International Yoga Day; the appearance of yoga practice rooms in major airports; and even the pervasive use of yoga images by the advertising industry.

Yoga therapy, the application of yoga for therapeutic purposes and as preventive medicine, is also on the increase, both in communities and within conventional medical systems. In recent years there has been a proliferation of yoga therapists (yoga teachers with additional training who work with individuals with a broad range of health conditions), yoga therapy training programs, and professional yoga therapy associations such as the International Association of Yoga Therapists, the Australian Association of Yoga Therapists, and the Japanese Association of Yoga Therapists. This growth is linked with and contributes to the expansion of integrative medicine practices, clinics, and centers, as evidenced by the founding and growth of the Academic Consortium for Integrative Medicine and Health.

In turn, this popularity of yoga and yoga therapy has been coincident with, and likely linked to, an increase in both biomedical research on the psychophysiology of yoga practices and clinical trials research on yoga therapy. This research has been driven in part by support of national government agencies that fund research on yoga, including the National Institutes of Health (NIH), especially the NIH’s National Center for Complementary and Integrative Health (NCCIH), in the United States, and the Ministry of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy (AYUSH) in India. A bibliometric analysis of yoga therapy research publications through 2003 revealed a total of 169 yoga clinical trial research publications (Khalsa, 2004); however, the number grew to 486 through 2013 (Jeter, Slutsky, Singh, & Khalsa, 2015), almost a three-fold increase in 10 years. The total number of published randomized controlled trials (RCTs) that included yoga interventions up to 2014 was 312, of which 205 were therapeutic efficacy trials and the remainder basic research trials (Cramer, Lauche, & Dobos, 2014). All three of these bibliometric analyses have demonstrated accelerating growth in the biomedical research on yoga and yoga therapy. The quantity and quality of this research has been sufficient to lead in turn to the publication of an increasing number of systematic reviews and meta-analyses of yoga trials (Bussing, Michalsen, Khalsa, Telles, & Sherman, 2012). The most obvious example of this is the expansion in cancer-related yoga research, with over a dozen systematic reviews or meta-analyses published through 2013. It is this growth in research on yoga and yoga therapy that has allowed for the publication of this book. One underlying reason for this boom in popularity and research in yoga and yoga therapy appears to be the burgeoning incidence of chronic lifestyle diseases, which our health care systems, and society as a whole, are failing adequately to address.

Yoga in lifestyle and stress-related diseases

Modern medicine has made tremendous progress in controlling infectious/communicable diseases such as tuberculosis, polio, and smallpox. In fact, communicable diseases are no longer the main cause of death worldwide. It is now the noncommunicable diseases (NCDs), in which lifestyle is the major causative factor, that have reached epidemic proportions, causing the majority of deaths worldwide. Indeed, NCDs are responsible for more deaths in developing countries than all other causes of mortality combined. Countries such as India and China now lead the world in the incidence of type 2 diabetes (T2DM) and likely soon will have the highest incidence of cancer as well, largely due to the widespread adoption of elements of a Western lifestyle. The World Health Organization (WHO) estimates that 80% of the NCD deaths are due to four main disease groups: (1) cardiovascular disease (heart disease and stroke); (2) cancer; (3) diabetes; and (4) respiratory diseases. Furthermore, NCDs are rapidly increasing in prevalence (Hunter & Reddy, 2013). The good news is that the overwhelming majority of the incidence of deaths from these four disease groups appears to be preventable (McGinnis & Foege, 1993).

These four disease groups are in large measure caused by four shared behavioral risk factors: tobacco use, physical inactivity, unhealthy diets, and the harmful use of alcohol (that can be viewed as an aspect of one’s diet) (Hunter & Reddy, 2013). To that list, one can add chronic psychological stress, which has both direct and indirect effects on NCDs by changing biology and influencing behavior. And, chronic stress in the modern world is highly prevalent. The American Psychological Association’s annual Stress in America surveys have been conducted since 2007 (American Psychological Association, 2014). In the 2014 survey, 42% of adults reported not doing enough to manage their stress or not being sure if they are doing enough, and 20% said they are not doing anything. Those of lower socioeconomic status—and greater NCD risk factors—reported greater stress levels than those of higher income. Other groups found more likely to be affected adversely by stress included women and young adults.

It is now widely accepted that modification of behavior in these four areas: (1) no tobacco use, (2) increasing physical activity, (3) eating a healthy diet with no or moderate alcohol consumption, and (4) managing stress could prevent the majority of disease-related suffering and deaths in our world, as well as the enormous expenses, both societal and individual, they cause. Yet, our health care systems, and the world as a whole, have made little investment in the area of NCD prevention relative to the investments in treatment, and treatment strategies have fallen short in trying to control NCDs. And this is an area where yoga can be extremely helpful. Although yoga is often perceived in the West as a form of physical activity with a focus mainly on movement and stretching, there are many Western yoga schools and styles incorporating traditional yoga practices, which include breathing exercises, deep relaxation, and meditation, among several others (see Chapter 2). In addition, many serious practitioners, including most yoga therapists, go beyond basic aspects of yoga to lead what can be called a “yogic lifestyle.” This lifestyle includes abstaining from tobacco; little or no alcohol consumption; maintaining a healthy diet with a focus on fresh, unprocessed, plant-based vegetarian or vegan foods; incorporating mindfulness into all behaviors and interactions; and leading a balanced life with a strong commitment to healthy behaviors. Clearly, broad adoption of a yogic lifestyle could help prevent many NCDs.

In addition, yoga’s ability to help manage the stress of modern life has been well documented (Sharma, 2...