Yoga for Clerkship

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Yoga and Medicine



3 Questions

� What is Yoga?

� What is the evidence that Yoga has

health benefits?� How do I use and prescribe Yoga as

a physician?



Yoga

� 5000 years old

� founded in India

� The word ³Yoga´

means ³yoke´ or ³unity´ translatedfrom Sanskrit, theclassical language of India.

� It also means ³discipline´ or ³effort.´



Yoga

� Yoga requires youto make an effortto unify your body

and mind.� You do this by

concentrating yourawareness on yourphysical bodythrough breathingand postures.



Meditation is part of Yoga

� Meditation is a technique in whichthe meditator seeks not only to

reach a deep state of relaxation, butto quiet the mind.

� The mind is a chattering monkeythat one tries to make quiet withmeditation.



Meditation seeks a state of

enlightenment, a freedom from thetyranny of our worries.



Types of Yoga

The approach to Yoga that f ocuses on postur es is called Hatha (haht-hah) Yoga.

� Ananda

� Ashthanga� Bikram

� Iyengar

� Kundalini

� Sivananda

� Viniyoga









Yoga breathing

� Abdominal breathing

� Sends a fax to the brain to relax

� Close your eyes

� Put your hand on your belly

� Imagine «..





Yoga postures (Asanas)

� Asanas are the heart of Hatha Yoga

� Stretching that maintains and enhancesflexibility

� Many poses are a form of isometricstrengthening exercise, which involve thecontraction of muscles without moving the

joint.� Isometric exercise is often used in

physical therapy for the rehabilitation of injured joints.





Meditation techniques

� Focused

� Mantra

� Walking



Focused Meditation

� is a technique in which you direct yourawareness onto something.

± a picture or statue of a deity

± a universal principle such as compassion orforgiveness

± or the syllable OM, the famous Hindumantra.



Mantra meditation

� In Sanskrit, the ³man´ in mantrameans ³to think,´ and ³tra´ suggestsinstrumentality.

� Mantra literally means an instrumentof thought.

� You repeat a word, phrase or soundin order to transcend the constantdistractions of the mind.



Transcendental Meditation

(TM)

� movement foundedby Maharshi

Mahesh Yogi of India.









Functional Mapping of

Meditation

� Meditation is a conscious mental processthat induces a set of integrated

physiologic changes termed the ³relaxation response´ by Herbert Benson.

� Functional magnetic resonance imaging(fMRI) was used to identify andcharacterize the brain regions that areactive during a simple form of meditation.



Results

� Significant signal increases were observed in thedorsolateral prefrontal and parietal cortices,hippocampus/parahippocampus, temporal lobe,pregenual anterior cingulate cortex, striatum, and

pre- and post-central gyri during meditation.

� This indicates that the practice of meditationactivates neural structures involved in attentionand control of the autonomic nervous system.

± Neuroreport. 2000 May 15;11(7):1581-5. Functionalbrain mapping of the relaxation response andmeditation. Lazar SW,«, Benson H.





Decr ease in Beta-wave activity after meditation



Question

� What is the evidence that

Yoga/meditation have healthbenefits?



There is good scientificevidence that exercise:

� Increases muscle and bone strength

� Increases lean muscle and decreases

body fat� Helps control weight

� Enhances your psychological well-

being, reduces depression� Reduces symptoms of anxiety and

improves your general mood



Yoga is exercise

� Stretching forflexibility

� Improved Strength

� Improved Balance



Evidence for Health Benefits of Yoga

� HTN ± Relaxation Response

� Carpal Tunnel Syndrome

� Asthma and improved vital capacity� Stress reduction to diminish the

many conditions caused or made

worse by stress.



Relaxation Response

� Herbert Benson,MD

� founding President

of the Mind/BodyMedical Institute

� Associate Professorof Medicine,Harvard MedicalSchool



Relaxation Response

� Sit comfortably with your eyes closed.

� Pay attention to your breathing, and

repeat a word or phrase or prayer silently to yourself as you exhale.

� When you notice your mind wandering

(It will) just notice it and passively bring

your attention back to your breathing.

± A f or m of meditation.



Autonomic NS

� Sympathetic NS

� Parasympathetic

NS



ight or Flight

� Whether you fight or run, your sympathetic nervous system will be on over dr ive

pumping out nor -epinephr ine.� What ar e the physiological

effects of this process?

� Why would you not want this to be a chronic state of

existence?



Fight or Flight

� Yoga and meditation decrease thissympathetic tone and reduce feelingsof stress and anxiety

� Many modern health problems areworsened by stress and anxiety

� Yoga works to decrease sympathetictone



Relaxation Response

� Significantly greater reductions inpsychological distress, anxiety, andperceived stress were found in the

experimental group who had learned therelaxation response.

± The evaluation of a mind/body intervention toreduce psychological distress and perceived

stress in college students. ± Deckro GR, «, Benson H.

± J Am Coll Health. 2002 May;50(6):281-7.



Yoga can prevent Seizures

� More than 50% reduction in seizurefrequency and duration comparedwith the control groups.

±Cochrane Database Systematic Rev.2000;(3)



Yoga for PoststrokeRehabilitation

� A yoga-based exercise program forpeople with chronic poststrokehemiparesis.

±Pilot study with four patients

� Gentle exercise program adapted forpeople who have had a stroke.

� Yoga showed some benefit.

±Bastille JV, Gill-Body KM. Phys Ther.

2004 Jan;84(1):33-48.





Pain in the hands

� Evaluation of a yoga based regimenfor treatment of osteoarthritis of thehands.

� The Yoga program was effective inproviding relief in hand

osteoarthritis.

Garfinkel MS, et al. J Rheumatol. 1994Dec;21(12):2341-3.





Carpal Tunnel Syndrome

� ³Current evidence shows significant short-term benefit from oral steroids, splinting,ultrasound and yoga.´

� Cochrane review, Issue 1, 2004.

� Garfinkel, et al. Yoga-Based Interventionfor Carpal Tunnel Syndrome. ARandomized Trial. JAMA. 1998



Eczema Stor y



Health Conditions in which

Yoga may help heal or treat� Arthritis� Allergies� Asthma� Hypertension

� Coronary ArteryDisease

� Irritable BowelSyndrome

� Heartburn (GERD)

� Constipation� Tension Headaches

and Migraines

� PMS and MenstrualDiscomfort

� Menopause

� Pain of the Back, Hips,Knees

� Depression & Anxiety

� Substance Abuse

� Skin Disorders

� Chronic FatigueSyndrome

� Overweight

� Sleep Problems



Yoga and Meditation to stay

healthy

� Exercise and relaxation can reduce

feelings of stress and keep the bodyand mind healthy



Question

� How do I use and prescribe Yoga as

a physician?



Treating Back Pain with

Yoga

� Similarities to PT

±Williams flexion exercises±McKenzie extension exercises

� Addition of breathing and relaxation





Yoga and Meditation

� As forms of medical treatments doYoga and Meditation meet standards

for being safe and effective?

� Safer than most medications

±No adverse effects such as allergicreactions, liver or kidney damage asseen with some medications.



Safety

� Safe from musculoskeletal injuries if you listen to your own body

� No pain and a lot of gain� Avoid postures that you can¶t handle

� Can continue in to older age ± 80year old yoga teacher in San Antonio



Effective

� We have reviewed some studies showingeffectiveness for certain conditions

� More studies are being done� People only continue Yoga when they find

that it works for them� Built in effectiveness meter� People often continue medications when

they see or feel no benefit and are subject

to real side effects

� Can be free ± cost effective



Yoga and Meditation

� Best when they ar e practiced as par t of an

overall healthy lifestyle:

± Good diet

± Aerobic exercise

± No smoking

± Safe dr inking

± Wear ing seatbelts



How to get started

� Books - hundreds

� Videos - many� Classes ± all over San Antonio

� http://www.texasyoga.com/dir ector ies/san

_antonio_ yoga.html



http://www.santosha.com/asanas/index.html



Conclusion

� Yoga can be valuable to:±You

±Your patients

� WE can write prescriptions forhealthy lifestyles (not just

medications)±Diet and exercise

±Smoking cessation

±Yoga







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Yoga for Clerkship