Much has changed since physician Dean Ornish included yoga in his groundbreaking protocol for preventing, treating, and reversing heart disease more than three decades ago. Back then, the idea of integrating yoga with modern medicine was seen as far-out.
Today’s picture is very different: As yoga has become an increasingly integral part of 21st-century life, scientists, armed with new tools that allow them to look ever deeper into the body, have been turning their attention to what happens physiologically when we practice yoga—not just asana but also pranayama and meditation. These physicians, neuroscientists, psychologists, and other researchers are uncovering fascinating evidence of how the practice affects us mentally and physically and may help to prevent and assist in the treatment of a number of the most common ailments that jeopardize our vitality and shorten our lives.
Dozens of yoga studies are under way at medical institutions around the country, including Duke, Harvard, and the University of California at San Francisco. Some of the research is funded by the National Institutes of Health. More studies are on the way, thanks in part to the work of researchers at the Institute for Extraordinary Living at the Kripalu Center for Yoga and Health, one of the first US research institutes to focus exclusively on yoga. And in India, scientist Shirley Telles heads up Patanjali Yogpeeth Research Foundation, which is spearheading studies large and small.
While studies of yoga’s impact on health are at an all-time high, experts say that much of the research is still in the early stages. But the quality is improving, says Sat Bir Khalsa, a Harvard neuroscientist who has studied yoga’s health effects for 12 years. It’s likely, he says, that the next decade will teach us even more about what yoga can do for our minds and bodies. In the meantime, the patterns beginning to emerge suggest that what we know about how yoga keeps us well may be just the tip of the iceberg.
Yoga shows promise as a treatment for relieving certain kinds of chronic pain. When German researchers compared Iyengar Yoga with a self-care exercise program among people with chronic neck pain, they found that yoga reduced pain scores by more than half. Examining yoga’s effects on a different kind of chronic pain, UCLA researchers studied young women suffering from rheumatoid arthritis, an often debilitating autoimmune disorder in which the immune system attacks the lining of the joints. About half of those who took part in a six-week Iyengar Yoga program reported improvements in measures of pain, as well as in anxiety and depression.
Yes, You Can!
Kim Innes, a Kundalini Yoga practitioner and a clinical associate professor at the University of Virginia, recently published a study on how yoga may benefit people who have a variety of health risk factors, including being overweight, sedentary, and at risk for type 2 diabetes. Forty-two people who had not practiced yoga within the previous year took part in an eight-week gentle Iyengar Yoga program; at the end of the program, more than 80 percent reported that they felt calmer and had better overall physical functioning. “Yoga is very accessible,” Innes says. “Participants in our trials, even those who thought they ‘could not do yoga,’ noted benefits even after the first session. My belief is that once people are exposed to gentle yoga practice with an experienced yoga therapist, they will likely become hooked very quickly.”
Ray of Light
Much attention has been given to yoga’s potential effect on the persistent dark fog of depression. Lisa Uebelacker, a psychologist at Brown University, got interested in examining yoga as a therapy for depression after studying and practicing mindfulness meditation. Because depressed people tend to be prone to rumination, Uebelacker suspected that seated meditation could be difficult for them to embrace. “I thought yoga might be an easier doorway, because of the movement,” she says. “It provides a different focus from worry about the future or regret about the past. It’s an opportunity to focus your attention somewhere else.” In a small study in 2007, UCLA researchers examined how yoga affected people who were clinically depressed and for whom antidepressants provided only partial relief. After eight weeks of practicing Iyengar Yoga three times a week, the patients reported significant decreases in both anxiety and depression. Uebelacker currently has a larger clinical trial under way that she hopes will provide a clearer picture of how yoga helps.
It’s taken the development of modern technologies like functional MRI screening to give scientists a glimpse of how yogic practices like asana and meditation affect the brain. “We now have a much deeper understanding of what happens in the brain during meditation,” says Khalsa. “Long-term practitioners see changes in brain structure that correlate with their being less reactive and less emotionally explosive. They don’t suffer to the same degree.” Scientists at the University of Wisconsin have shown that meditation increases the activity of the left prefrontal cortex—the area of the brain that’s associated with positive moods, equanimity, and emotional resilience. In other words, meditating regularly may help you weather life’s ups and downs with greater ease and feel happier in your daily life.
Asana, pranayama, and meditation all train you to fine-tune your attention, whether by syncing your breathing with movement, focusing on the subtleties of the breath, or letting go of distracting thoughts. Studies have shown that yogic practices such as these can help your brain work better. Recently, University of Illinois researchers found that immediately following a 20-minute session, study participants completed a set of mental challenges both faster and more accurately than they did after a brisk walk or a jog.
Researchers are in the earliest stages of examining whether yogic practices could also help stave off age-related cognitive decline. “The yogic practices that involve meditation would likely be the ones involved, because of the engagement of control of attention,” says Khalsa. Indeed, research has shown that parts of the cerebral cortex—an area of the brain associated with cognitive processing that becomes thinner with age—tend to be thicker in long-term meditators, suggesting that meditation could be a factor in preventing age-related thinning.
A 2013 review of 17 clinical trials concluded that a regular yoga practice that includes pranayama and deep relaxation in Savasana (Corpse Pose), practiced for 60 minutes three times a week, is an effective tool for maintaining a healthy weight, particularly when home practice is part of the program.
In our revved-up, always-on world, our bodies spend too much time in an overstimulated state, contributing to an epidemic of sleep problems. A recent Duke University analysis of the most rigorous studies done on yoga for psychiatric conditions found promising evidence that yoga can be helpful for treating sleep disorders. Asana can stretch and relax your muscles; breathing exercises can slow your heart rate to help prepare you for sleep; and regular meditation can keep you from getting tangled up in the worries that keep you from drifting off.
In India, women who took part in a 12-week yoga camp reported improvements in several areas of sexuality, including desire, orgasm, and overall satisfaction. Yoga (like other exercise) increases blood flow and circulation throughout the body, including the genitals. Some researchers think yoga may also boost libido by helping practitioners feel more in tune with their bodies.
We’re used to thinking of inflammation as a response that kicks in after a bang on the shin. But increasing evidence shows that the body’s inflammatory response can also be triggered in more chronic ways by factors including stress and a sedentary lifestyle. And a chronic state of inflammation can raise your risk for disease.
Researchers at Ohio State University found that a group of regular yoga practitioners (who practiced once or twice a week for at least three years) had much lower blood levels of an inflammation-promoting immune cell called IL-6 than a group new to yoga. And when the two groups were exposed to stressful situations, the more seasoned practitioners showed smaller spikes of IL-6 in response. According to the study’s lead author, Janice Kiecolt-Glaser, the more experienced practitioners went into the study with lower levels of inflammation than the novices, and they also showed lower inflammatory responses to stress, pointing to the conclusion that the benefits of a regular yoga practice compound over time.
While the fountain of youth remains a myth, recent studies suggest that yoga and meditation may be associated with cellular changes that affect the body’s aging process. Each of our cells includes structures called telomeres, bits of DNA at the end of chromosomes that get shorter each time a cell divides. When telomeres get too short, the cells can no longer divide and they die. Yoga, it seems, may help to preserve their length. Men with prostate cancer who took part in a version of the Ornish healthy lifestyle program, which included an hour a day of yoga, six days a week, showed a 30 percent jump in the activity of a key telomere-preserving enzyme called telomerase. In another study, stressed care-givers who took part in a Kundalini Yoga meditation and chanting practice called Kirtan Kriya had a 39 per-cent increase in telomerase activity, compared with people who simply listened to relaxing music.
Many studies have suggested that yoga can fortify the body’s ability to ward off illnesses. Now one of the first studies to look at how yoga affects genes indicates that a two-hour program of gentle asana, meditation, and breathing exercises alters the expression of dozens of immune-related genes in blood cells. It’s not clear how the genetic changes observed in this study might support the immune system. But the study provides striking evidence that yoga can affect gene expression—big news that suggests yoga may have the potential to influence how strongly the genes you’re born with affect your health.
Your Spine on Yoga
Taiwanese researchers scanned the vertebral disks of a group of yoga teachers and compared them with scans of healthy, similar-aged volunteers. The yoga teachers’ disks showed less evidence of the degeneration that typically occurs with age. One possible reason, researchers speculate, has to do with the way spinal disks are nourished. Nutrients migrate from blood vessels through the tough outer layer of the disk; bending and flexing may help push more nutrients through this outer layer and into the disks, keeping them healthier.
Keep Your Heart Healthy
Despite advances in both prevention and treatment, heart disease remains the no. 1 killer of both men and women in the United States. Its development is influenced by high blood pressure, high cholesterol, high blood sugar, and a sedentary lifestyle—all of which can potentially be reduced by yoga. Dozens of studies have helped convince cardiac experts that yoga and meditation may help reduce many of the major risk factors for heart disease; in fact, a review of no fewer than 70 studies concluded that yoga shows promise as a safe, effective way to boost heart health. In a study this year by researchers at the University of Kansas Medical Center, subjects who participated in twice-weekly sessions of Iyengar Yoga (including pranayama as well as asana) significantly cut the frequency of episodes of atrial fibrillation, a serious heart-rhythm disorder that increases the risk of strokes and can lead to heart failure.
By gently taking joints—ankles, knees, hips, shoulders—through their range of motion, asana helps keep them lubricated, which researchers say may help keep you moving freely in athletic and everyday pursuits as you age.
Watch Your Back
Some 60 to 80 percent of us suffer from low-back pain, and there’s no one-size-fits-all treatment. But there’s good evidence that yoga can help resolve certain types of back troubles. In one of the strongest studies, researchers at Group Health Research Institute in Seattle worked with more than 200 people with persistent lower-back pain. Some were taught yoga poses; the others took a stretching class or were given a self-care book. At the end of the study, those who took yoga and stretching classes reported less pain and better functioning, benefits that lasted for several months. Another study of 90 people with chronic low-back pain found that those who practiced Iyengar Yoga showed significantly less disability and pain after six months.
Control Blood Pressure
One-fifth of those who have high blood pressure don’t know it. And many who do struggle with the side effects of long-term medication. Yoga and meditation, by slowing the heart rate and inducing the relaxation response, may help bring blood pressure down to safer levels. Researchers at the University of Pennsylvania recently conducted one of the first randomized, controlled trials of yoga for blood pressure. They found that 12 weeks of Iyengar Yoga reduced blood pressure as well as or better than the control condition of nutrition and weight-loss education. (If you have high blood pressure, consult with your doctor and make sure it’s under control before you practice inversions.)
Down With Diabetes
Researchers at the University of Pittsburgh School of Medicine found that adults at risk for type 2 diabetes who did yoga twice a week for three months showed a reduction in risk factors including weight and blood pressure. While the study was small, all who began the program stuck with it throughout the study, and 99 percent reported satisfaction with the practice. In particular, they reported that they liked the gentle approach and the support of the group. If larger, future studies show similar results, the researchers say, yoga could gain credence as a viable way of helping people stave off the disease.
Many women have turned to yoga to help them cope with the symptoms of menopause, from hot flashes to sleep disturbances to mood swings. A recent analysis of the most rigorous studies of yoga and menopause found evidence that yoga—which included asana and meditation—helps with the psychological symptoms of menopause, such as depression, anxiety, and insomnia. In one randomized controlled trial, Brazilian researchers examined how yoga affected insomnia symptoms in a group of 44 postmenopausal women. Compared with women who did passive stretching, the yoga practitioners showed a big drop in incidence of insomnia. Other, more preliminary research has suggested that yoga may also help to reduce hot flashes and memory problems, too.
Recent studies have suggested that exercise is linked with increased levels of a brain chemical called gamma-aminobutyric acid (GABA), which is associated with positive mood and a sense of well-being. It turns out that Iyengar Yoga can also increase the levels of this chemical in the brain, more so than walking, according to a Boston University study. In another study, a group of women who were experiencing emotional distress took part in two 90-minute Iyengar Yoga classes a week for three months. By the end of the study, self-reported anxiety scores in the group had dropped, and measures of overall well-being went up.
If you’ve felt the thrill of discovering you can hold Chaturanga for longer and longer periods, you’ve experienced how yoga strengthens your muscles. Standing poses, inversions, and other asanas challenge muscles to lift and move the weight of your body. Your muscles respond by growing new fibers, so that they become thicker and stronger—the better to help you lift heavy grocery bags, kids, or yourself into Handstand, and to maintain fitness and function throughout your lifetime.
When you were a kid, your day included activities that tested your balance—walking along curbs, hopping on your skateboard. But when you spend more time driving and sitting at a desk than in activities that challenge your balance, you can lose touch with the body’s magical ability to teeter back and forth and remain upright. Balance poses are a core part of asana practice, and they’re even more important for older adults. Better balance can be crucial to preserving independence, and can even be lifesaving—falls are the leading cause of injury-related death in people over 65.
Bringing Yoga and Western Medicine Together:
Duke University’s Integrative Medicine department in Durham, NC, has lived up to its name by integrating yoga into medicine and medicine into yoga. The department is one of the only major medical centers to offer yoga teacher training. Its two programs, “Thera-peutic Yoga for Seniors” and “Yoga of Awareness for Cancer,” are taught by a team of yoga instructors, doctors, physical therapists, and mental health professionals.
These yoga teacher trainings accept about 100 people a year and involve elements of asana, pranayama, meditation, and mindfulness working together as adjuncts to the conventional medical treatments that patients may also be receiving simultaneously. Once training is complete, teachers can work on contract for hospitals and other health agencies.
Kimberly Carson, the founder and codirector of the yoga training programs, stresses that what sets the programs apart is their research-based approach: Medicine listens best when you speak its language, says Carson, a yoga therapist who has taught in medical settings for more than 15 years. “The evidence base is what the medical community listens to.”
Essential to the program’s success, says Carson, is the staff’s commitment to thinking critically about how they promote the benefits of yoga. “The quickest way to shut doors is to state as fact claims that aren’t substantiated,” she says.
Luckily, the evidence base for yoga and other alternative methods is fast growing, and Duke has been a forerunner in opening the lines of communication between yoga and medicine.
Located in one of the best academic medical centers and in one of the most doctor-friendly cities in the country, the Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital is well poised to train new doctors to incorporate mind-body techniques into their practice. Its founder and director emeritus, Dr. Herbert Benson, pioneered research on the relaxation response as a powerful antidote to the stress response; he was also one of the first to illustrate that meditation changes metabolism, heart rate, and brain activity as a result of the relaxation response. This commitment to research is still what makes the institute stand out: Benson and his colleagues recently published a landmark study illustrating some of the changes in gene expression that can come from practices that elicit the relaxation response, including meditation and yoga.
Physicians at the institute help treat patients for everything from heart disease to diabetes to infertility. Individual therapeutic yoga instruction is offered as an adjunctive approach for a wide variety of conditions, both physical and mental. Darshan Mehta, the institute’s medical director and director of medical education, says that along with maintaining its commitments to research and patient care, the Benson-Henry Institute is dedicated to educating medical students and residents in integrative medicine. “Boston is famous for training leaders in medicine,” Mehta says. “We need to expose the next generation of doctors to the benefits of mind-body medicine. My hope is that after studying at the Benson-Henry Institute they’ll be able to at least recognize value in it and perhaps add it to their practices in some way.”
Caring Health Care: Urban Zen Integrative Therapy Program
The brainchild of Donna Karan, Rodney Yee, Colleen Saidman Yee, and Beth Israel’s chair of integrative medicine, Woodson Merrell, MD, the Urban Zen Integrative Therapy program seeks to strengthen the human element in hospital-based health care and to lessen the pain and anxiety many patients experience when undergoing treatment for cancer and other illnesses. Launched in 2009, the program offers a 500-hour training for yoga teachers and health care professionals in five healing modalities: yoga therapy, Reiki, essential-oil therapy, nutrition, and contemplative care. Included in the training are 100 hours of clinical rotations, carried out at participating hospitals and long-term care facilities in New York; Los Angeles; Columbus, Ohio; and Port-au-Prince, Haiti.
“We’re bringing mindfulness into arenas where there is often only anxiety, panic, stress, and crisis states,” says Codirector Rodney Yee. “We all realize mindfulness and meditation are so important to daily life. This is a way to bring this to patients in a medical setting, to support patients’ needs.” For example, depending on the needs of the patient, a certified therapist might help patients do in-bed yoga poses, breathing techniques, and meditation that they can then repeat on their own.
Yee says he’s been amazed by the receptivity of the medical community toward the program. Old stigmas are dissolving, he says, and new attitudes are emerging. But it’s a two-way street, he adds. “The yoga community has our own work cut out for us, keeping up with the science and being open to addressing the issues that will affect yoga’s role in Western medicine for years to come.”