It’s not just about the calories you burn on the mat. Experts say the stress-busting benefits of a regular yoga practice can help with weight control, too
7 Myths About Yoga
If you’ve been avoiding the mat or making excuses, here are seven myth busters to give you a push!
Yoga comes with many health benefits, from strengthening muscles to improving sleep to reducing stress. Can it help with weight loss, too?
There are a few different ways yoga can help with weight loss, and it’s not just a matter of the calories you burn on your yoga mat, says Judi Bar, the yoga program manager at Cleveland Clinic Center for Integrative Medicine in Ohio, who is certified by the International Association of Yoga Therapists and Yoga Alliance.
“Yoga, if done right, becomes a lifestyle change,” she says, which in turn can help increase physical activity and decrease emotional eating. And it can help you manage stress, which can also help with weight maintenance, she says.
Bar says she’s seen yoga help with weight loss in people she works with in her practice. And her research says so, too.
Bar is coauthor of a study review in which she and her team reviewed dozens of studies evaluating the effects of yoga on weight loss.
The data showed that yoga is tied to weight loss and weight maintenance because of a handful of factors, including energy expenditure during yoga sessions, encouraging more exercise by reducing back pain and joint pain, heightening mindfulness, improving mood and reducing stress, and helping yogis feel more connected to their bodies, their satiety, and eating habits.
Another study analyzed data collected from interviews with 20 adults who reported losing weight through a yoga practice. The participants’ answers pointed to five factors the researchers concluded helped with weight loss: a shift to healthier eating, impact of the yoga community and culture, physical changes, psychological changes, and the belief that the yoga weight loss experience was different than past weight loss experiences.
If you’re trying to lose or maintain weight, here are three big ways that yoga may help, according to Bar and other experts:
Yoga helps you practice mindfulness, which can help when it comes to sticking with all the facets of a diet plan, like an eating plan and physical activity.Iuliia Komarova/Getty Images
1. Yoga Can Help With Mindful Eating
You’re strengthening more than just your muscles on your yoga mat, says Sat Bir Singh Khalsa, PhD, an associate professor of medicine at Brigham and Women’s Hospital in Boston.
When you’re holding a posture for an extended period of time, you’re connecting with how your body feels, Dr. Khalsa says. Your instructor may be asking you to monitor your breath and pay attention to what your mind and body are telling you, which is a way of learning and practicing mindfulness.
And practicing mindfulness on your yoga mat can help when it comes to practicing mindful eating habits, too. Mindful eating is recognizing hunger cues and limiting binge eating. Over time (and with practice) you may even zero in on which foods make you feel fueled and energized, and which ones have more negative effects (like making you feel lethargic or bloated), Khalsa says. And all of these behaviors can help you stick with a diet or weight loss eating plan — or in making healthier food choices overall.
Khalsa cites research that found that yoga has been linked to changes in eating behavior, specifically cutting back on dietary fat and adding more fresh vegetables, whole grains, and soy-based products.
Another study analyzed survey data from 159 women who either regularly practiced yoga or cardio-based exercise. The yogis were significantly less likely to have disordered eating patterns than the cardio-based exercisers.
“This is where yoga shines,” Khalsa says. It’s not just about the physical activity you’re doing. “It’s about listening to your body’s cues.”
2. Yoga Can Help You Manage Stress
There are many ways stress can contribute to weight gain — and particularly unmanaged, chronic stress. Yoga can help lower chronic stress levels.
Breathwork and meditation are the cornerstones to yoga practice. And both contribute to boosting energy, improving mood, and lowering stress levels, says Sundar Balasubramanian, PhD, assistant professor at the Medical University of South Carolina in Charleston, whose research focuses on how yogic breathing can promote well-being in people with chronic health problems and other diseases. (Dr. Balasubramanian is also founder of the PranaScience Institute, which offers courses in yogic breathing and an International Association of Yoga Therapists–certified yoga therapist.)
“Stress can make weight loss very difficult because it can cause cortisol to rise, stress-eating, and trouble sleeping,” Balasubramanian explains. Deep breathing helps undo stress and reverse some of these negative effects that can make weight loss more difficult (or contribute to weight gain).
There are physiological changes that happen in the body in response to breathing exercises, Balasubramanian says. “Studies have shown how mindfulness exercises reduce the amount of cortisol in our bodies.”
One study review that analyzed data from 42 studies suggested that yoga was associated with lower levels of evening cortisol, waking cortisol, resting heart rate, and cholesterol levels.
3. Yoga Helps Build Muscle
Building muscle mass is another way yoga helps with weight loss and weight maintenance.
“When we think of strengthening muscles, we think we have to go to the weight room and pump iron. In yoga, we’re using our own body weight as a form of resistance. Your whole body is working to keep you in balance so everything gets a workout,” says Carol Krucoff, an instructor certified by the International Association of Yoga Therapists and Yoga Alliance and a yoga therapist at Duke Integrative Medicine in Durham, North Carolina.
Think of holding your body in place in a plank pose. You’re using the muscles of the shoulders, core, hips, and legs to hold your body up, she says. After coming out of a plank, you may flow into a Downward-Facing Dog pose, activating another set of muscles in your forearms, shoulders, and back. This muscle building burns calories, Krucoff says.
One study review that looked at 30 trials with more than 2,000 participants concluded that yoga can reduce waist-hip ratio in healthy adults, as well as body mass index (BMI) in people who are overweight or obese.
Other research has found that even slower, restorative yoga classes improved fasting glucose levels in people who were overweight or obese — a sign of improved metabolic health.
How Can I Make Yoga Part of My Weight Loss Plan?
If you’re considering adding yoga into your weight loss plans, the experts shared the following tips to get you started:
Start slowly. The key to getting started with yoga — or any form of exercise — is to begin with an introduction. Bar says beginners should avoid harder, faster styles of yoga that include words like “hot,” “Bikram,” “power,” or “flow.” You need to choose a style that’s easy to follow and won’t lead to injuries so you can safely build up flexibility and strength. Look for classes labeled beginner, which are more likely to explain how to do the poses.
Make adjustments as needed. If you’re out of shape or trying to lose a significant amount of weight, choose a form of yoga that suits your needs — or you may need to make adjustments to various poses you can’t fully do when you start. Krucoff teaches chair yoga to exercisers who have issues with their joints, knees, and hips so they can practice while comfortably sitting down. Seek out live classes, during which you can ask an instructor about how to modify a pose or exercise to meet your needs.
Find a style, class, and instructor that fits you to a tee. Khalsa says you may need to try out a few different classes, styles of yoga, and instructors until you find the perfect fit. Some focus more on breathing exercises and meditation. Some focus more on strengthening movements. Some move along at a faster tempo; others are slower paced. “The most important thing is to engage in a yoga practice that you can sustain. When you do, you’ll find you will then continue with the practice and reap the long-term benefits,” he says.
Incorporate other forms of exercise, too. Most yoga styles involve some muscle-strengthening, but not every class will give you a cardiovascular workout. So pair a regular yoga practice with some aerobic exercise, Bar says, like walking, jogging, biking, or other activities that get your heart rate up. Khalsa practices yoga alongside other sports, such as racquetball. Krucoff suggests practicing a gentle style of yoga as a type of active recovery (for those who do other high-intensity workouts, too).
Keep at it. Practicing yoga is a habit you’ll need to forge slowly, according to Subramanian. He says whichever yoga practice you choose to incorporate into your weight loss plans, it’s not going to work if you only do it once. Pick a practice you enjoy, that you can do weekly or more frequently, and stick to it to see results.
Seek professional input. Not sure how to make yoga part of your weight loss plan? Or if you are having pain, other uncomfortable symptoms, or feel overwhelmed with starting a new yoga practice, seek further guidance from your primary care doctor. If they have a background in integrative medicine, they may be able to help you build a customized program for your specific health goals. Or they may refer you to see a physical therapist who is trained in customizing rehabilitative exercise programs for patients and has expertise in yoga.
New research finds that simple exercises like walking, jogging, yoga, and strength training can help ease symptoms of depression. enigma_images/Getty Images
A review of 218 scientific trials has found that walking, jogging, yoga, and strength training may be the most effective exercises for relieving symptoms of depression.
The more vigorous the exercise, the greater the mental health benefits are likely to be.
Experts say this is likely due to the release of feel-good hormones, engagement in a routine, and the social interaction exercise often provides.
It can be difficult to exercise when you’re depressed, so experts recommend starting slow and finding something you enjoy.
Have you ever noticed that your mood improves when you exercise?
New research has found that certain kinds of exercise – specifically walking, jogging, yoga, and strength training – seem to be the most effective at easing symptoms of depression.
The research published in The BMJ found that these exercises were effective at reducing depression when used alone or alongside established treatments such as psychotherapy and medication.
Furthermore, the results suggest that, while low intensity exercise is beneficial, the more vigorous the activity, the greater the benefits are likely to be.
To assess the existing data, the study authors reviewed 218 relevant trials involving 14,170 participants that compared exercise as a treatment for depression with established treatments, like antidepressants and cognitive behavioral therapy.
Moderate reductions in depression were found in walking or jogging, yoga, strength training, mixed aerobic exercises, and tai chi or qi gong.
Moderate effects were also found when exercise was combined with SSRI antidepressants or aerobic exercise was combined with psychotherapy, which suggests that exercise could provide added benefit alongside these established treatments.
While the authors acknowledge that the quality of evidence is low and very few trials monitored participants for one year or more, they say the results suggest that these forms of exercise “could be considered alongside psychotherapy and drugs as core treatments for depression.”
In particular, they note that a combination of social interaction, mindfulness, and immersion in green spaces may help explain the positive effects.
Clinical psychologist Charlotte Russell, who was not involved int the study, isn’t surprised by these findings and says there are likely several mechanisms that explain the effect exercise has on mood.
One of these is the impact of neurochemicals, including dopamine, serotonin, and endorphins, which are released when we exercise.
Serotonin stabilizes mood, dopamine contributes to feelings of happiness, and endorphins can provide a natural high.
Additionally, Russell says exercise can provide a sense of meaning and engagement in routine. There is often a social element as well, and all of these factors can positively influence our mental health.
“Building exercise into your routine also breaks the cycle of worsening mood and decreased activity that we commonly see in depression,” Russell adds.
“When we are inactive and not using our body, this can contribute to a sense of sluggishness and low motivation, which can quickly lead to a downward spiral. Regular exercise breaks this and maintains a sense of well-being,” she explains.
You might be wondering why walking, jogging, yoga, and strength training appear to be particularly effective at relieving symptoms of depression.
With walking and jogging, Russell says the benefits may lie in the fact that these exercises are often done outside.
“This typically offers a feeling of connection with nature, and we know that this can be beneficial for us psychologically,” she explains.
Yoga, meanwhile, teaches you to focus on your breathing, something Russell says can lessen feelings of anxiety and create an awareness of our internal state.
“The latter is a skill that can be very beneficial in terms of managing difficult thoughts and feelings,” she notes.
Russell says strength training can help you feel stronger in your body and allow you to complete everyday tasks more easily.
“This has a protective effect on our sense of self and mood,” she notes.
Why does vigorous exercise seem to be best?
Clinical hypnotherapist and wellness coach Geraldine Joaquim, who was not involved in the study, says the more vigorous the exercise, the more you’ll feel those high-achievement hormones, which can have a huge internal effect.
But, she says, taking things at your own pace is more important.
If you live with depression, it isn’t always easy to find your get-up-and-go.
“It takes more effort to move forward when you’re depressed because you’re on an uphill battle to create hormonal activity,” Joaquim explains.
“That’s why it’s important to start where you are and build slowly. That might mean simply putting trainers on and walking to the end of your garden. Doing it again. And again. Then expanding, going to the end of the road, for example.”
By working slowly and being kind to yourself, Joaquim says you are gently promoting the production and release of hormones like serotonin, dopamine, and oxytocin that make you feel good.
Joaquim advises aiming for around 80% of your capacity rather than going all out and exhausting yourself if you’re not sure how much is too much when you’re exercising.
“Notice what’s happening in your body as you move, enjoy the feelings of stretching muscles, deep breathing, and feeling strong – and remember, nothing is set in stone. You can change what you’re doing at any time,” she notes.
Meanwhile, Russell points out that many gyms and fitness studios offer classes and exercise courses that are suitable for beginners.
“Choosing this option can be reassuring for many as everyone will be in a similar situation,” she says. “However, if an in-person class seems too daunting, start with an online class to build your confidence.”
A new mouse study investigated the impact of SSRIs on brain development.
A new mouse study found antidepressant use during pregnancy may influence brain development in utero.
Most antidepressants are safe to use during pregnancy, according to experts. Depending on the severity of mental illness, withholding medication can lead to more severe health risks.
Other treatments for depression include cognitive behavioral therapy, interpersonal psychotherapy, support groups, mindfulness, yoga, and exercise.
A new mouse study found taking antidepressants during pregnancy may affect brain development in utero and be a risk factor for developing mental health disorders later in life.
Researchers examined the impact of a chemical called fluoxetine on mice.
Fluoxetine elevates the amount of serotonin in the brain and is typically used in selective serotonin reuptake inhibitors (SSRI) medications such as Prozac and Sarafem which are used to help treat depression and perinatal depression. The researchers looked at how serotonin influences prefrontal cortex development in a fetus – specifically, the effect of deficiency and surplus of serotonin on brain development in mice.
Results showed that serotonin not only impacts overall brain function but also impacts how individual connections between neurons change and adapt. This, in turn, affects the way the brain learns.
“This is certainly a fascinating scientific study on postnatal development in the mouse brain but how it applies to the human brain still remains a question,” said Dr. Michael Cackovic, maternal-fetal medicine physician at Bridgeport Hospital.
Cackovic wasn’t involved in the study.
Most brain development in humans occurs in the first two years of life and 90% before kindergarten so it would make sense that giving “pups” this medication early in life could potentially cause a problem, Cackovic explained.
Researchers looked at the effects of serotonin on the part of a developing brain called prefrontal cortex when it is exposed to fluoxetine.
Fluoxetine goes into the placenta but also into breast milk.
“All known SSRI medications readily pass through the placenta and enter the fetal circulation,” said Dr. Jay Gingrich, professor of developmental psychology at Columbia University Vagelos College of Physicians and Surgeons. “There are several studies that have examined the health and mental health outcomes of children exposed to SSRIs in utero. Because serotonin receptors and pathways are highly conserved through evolution (across distant species), there has been a presumption that findings in rodents may likely be relevant to human brain development.”
Gingrich continued: “This has been difficult to prove unequivocally, but several studies have found increased rates of depression, anxiety, and adjustment disorders in SSRI-exposed children as they age into adolescence. Other studies have found increased rates of autism, but most of those studies have not controlled for maternal mental health and several studies failed to find a similar linkage.”
The risk of exposure through breast milk is expected to be far lower than through placental passage and should not dissuade mothers from breastfeeding or resuming SSRI use during this period, he added.
These findings do not mean that people who wish to become pregnant should stop taking SSRIs immediately, according to experts.
“There is a tremendous amount of data that supports use of an SSRI during pregnancy when it is taken to help the person achieve remission or maintain remission of their depression and/or anxiety,” said Dr. Katherine Campbell, associate professor of obstetrics, reproductive sciences at Yale School of Medicine.
Campbell, who did not work on the study, did clarify that infants can have symptoms if their parent is on SSRIs while pregnant.
“When babies are born to parents who are on fluoxetine (or other SSRI), the baby can have withdrawal symptoms that can start after birth,” Campbell said. “Withdrawal symptoms can include irritability, jitteriness, and fast breathing. There are newer SSRIs on the market that cross the placenta and cross into breast milk in lower concentrations.”
While there may be risks in taking SSRIs while pregnant, there are also risks of experiencing mental health disorders. Experts point out that untreated mental illness has significant and well-established consequences to maternal and infant health.
“Antidepressants, and selective serotonin reuptake inhibitors (SSRIs) specifically, are the most studied class of medications in pregnancy and the clinical consensus based on the extensive literature (in human studies), is that they are generally safe to use in pregnancy and in lactation when medically indicated (with the exception of paroxetine, which is usually not prescribed or used in pregnancy due to equivocal evidence on possible minor cardiac malformations),” said Dr. Ariadna Forray, associate professor of psychiatry at Yale School of Medicine and Director at the Center for Wellbeing of Women and Mothers, Psychiatry; Yale Medical Director, ACCESS Mental Health for Moms.
Forray was not involved in the study.
“The irony is that both untreated maternal depression and the use of antidepressants both increase the risk for anxiety and depressive disorders in the offspring in later life,” Gingrich said. “This conundrum is what has made it so difficult to discern whether SSRI use in pregnancy is a net positive to the child or whether we are exacerbating what trends were expected based on maternal history.”
Experts say if you are pregnant and taking SSRIs you can speak with your physician about whether or not it would make sense to stop taking the medication.
In many clinical scenarios, it is problematic to withhold medication treatment during pregnancy because of the severity of the mother’s symptoms.
“We have been working in this area for 20 years in attempt to provide a clearer risk-benefit profile to clinicians and their patients to help inform better decisions. This work is ongoing,” Gingrich added.
There are various non-pharmacological interventions to help treat depression symptoms that people can explore after talking to their psychiatrist and physician if they want to avoid SSRIs.
“Evidence-based interventions include cognitive behavioral therapy and interpersonal psychotherapy,” said Forray. “Things like support groups, mindfulness, yoga and exercise can also be helpful additions to evidence-based treatments.”
In addition, “there are several effective psychotherapies for depression during pregnancy and in the post-partum period (IPT, CBT) and there are new non-SSRI medications specifically indicated for post-partum depression (e.g., Zurzuvae or zuranolone),” Gingrich explained. “The US needs to improve the availability and reimbursement of such non-pharmacologic therapies for patients in need. These are often barriers to obtaining appropriate psychotherapy for the expecting mother.”
According to a new mouse study, antidepressant use during pregnancy may affect brain development in utero. However, further research is needed.
The clinical consensus is that most antidepressants are safe to use during pregnancy, according to experts. It is important to note that withholding medication can pose greater health risks for the pregnant person and child.
Aside from medication, there are other ways to help treat symptoms of depression. These include cognitive behavioral therapy, interpersonal psychotherapy, support groups, mindfulness, yoga, and exercise.
New research finds that simple exercises like walking, jogging, yoga, and strength training can help ease symptoms of depression.
A review of 218 scientific trials has found that walking, jogging, yoga, and strength training may be the most effective exercises for relieving symptoms of depression.
The more vigorous the exercise, the greater the mental health benefits are likely to be.
Experts say this is likely due to the release of feel-good hormones, engagement in a routine, and the social interaction exercise often provides.
It can be difficult to exercise when you’re depressed, so experts recommend starting slow and finding something you enjoy.
Have you ever noticed that your mood improves when you exercise?
New research has found that certain kinds of exercise – specifically walking, jogging, yoga, and strength training – seem to be the most effective at easing symptoms of depression.
The research published in The BMJ found that these exercises were effective at reducing depression when used alone or alongside established treatments such as psychotherapy and medication.
Furthermore, the results suggest that, while low intensity exercise is beneficial, the more vigorous the activity, the greater the benefits are likely to be.
To assess the existing data, the study authors reviewed 218 relevant trials involving 14,170 participants that compared exercise as a treatment for depression with established treatments, like antidepressants and cognitive behavioral therapy.
Moderate reductions in depression were found in walking or jogging, yoga, strength training, mixed aerobic exercises, and tai chi or qi gong.
Moderate effects were also found when exercise was combined with SSRI antidepressants or aerobic exercise was combined with psychotherapy, which suggests that exercise could provide added benefit alongside these established treatments.
While the authors acknowledge that the quality of evidence is low and very few trials monitored participants for one year or more, they say the results suggest that these forms of exercise “could be considered alongside psychotherapy and drugs as core treatments for depression.”
In particular, they note that a combination of social interaction, mindfulness, and immersion in green spaces may help explain the positive effects.
Clinical psychologist Charlotte Russell, who was not involved int the study, isn’t surprised by these findings and says there are likely several mechanisms that explain the effect exercise has on mood.
One of these is the impact of neurochemicals, including dopamine, serotonin, and endorphins, which are released when we exercise.
Serotonin stabilizes mood, dopamine contributes to feelings of happiness, and endorphins can provide a natural high.
Additionally, Russell says exercise can provide a sense of meaning and engagement in routine. There is often a social element as well, and all of these factors can positively influence our mental health.
“Building exercise into your routine also breaks the cycle of worsening mood and decreased activity that we commonly see in depression,” Russell adds.
“When we are inactive and not using our body, this can contribute to a sense of sluggishness and low motivation, which can quickly lead to a downward spiral. Regular exercise breaks this and maintains a sense of well-being,” she explains.
You might be wondering why walking, jogging, yoga, and strength training appear to be particularly effective at relieving symptoms of depression.
With walking and jogging, Russell says the benefits may lie in the fact that these exercises are often done outside.
“This typically offers a feeling of connection with nature, and we know that this can be beneficial for us psychologically,” she explains.
Yoga, meanwhile, teaches you to focus on your breathing, something Russell says can lessen feelings of anxiety and create an awareness of our internal state.
“The latter is a skill that can be very beneficial in terms of managing difficult thoughts and feelings,” she notes.
Russell says strength training can help you feel stronger in your body and allow you to complete everyday tasks more easily.
“This has a protective effect on our sense of self and mood,” she notes.
Why does vigorous exercise seem to be best?
Clinical hypnotherapist and wellness coach Geraldine Joaquim, who was not involved in the study, says the more vigorous the exercise, the more you’ll feel those high-achievement hormones, which can have a huge internal effect.
But, she says, taking things at your own pace is more important.
If you live with depression, it isn’t always easy to find your get-up-and-go.
“It takes more effort to move forward when you’re depressed because you’re on an uphill battle to create hormonal activity,” Joaquim explains.
“That’s why it’s important to start where you are and build slowly. That might mean simply putting trainers on and walking to the end of your garden. Doing it again. And again. Then expanding, going to the end of the road, for example.”
By working slowly and being kind to yourself, Joaquim says you are gently promoting the production and release of hormones like serotonin, dopamine, and oxytocin that make you feel good.
Joaquim advises aiming for around 80% of your capacity rather than going all out and exhausting yourself if you’re not sure how much is too much when you’re exercising.
“Notice what’s happening in your body as you move, enjoy the feelings of stretching muscles, deep breathing, and feeling strong – and remember, nothing is set in stone. You can change what you’re doing at any time,” she notes.
Meanwhile, Russell points out that many gyms and fitness studios offer classes and exercise courses that are suitable for beginners.
“Choosing this option can be reassuring for many as everyone will be in a similar situation,” she says. “However, if an in-person class seems too daunting, start with an online class to build your confidence.”
“My back is killing me!” Haven’t we all heard that countless times? And not just in our clinical practice, classrooms, at dinner parties, out shopping, or during phone calls with friends and family. How many of us stop in our tracks to offer help on the spot?
I’ve shared various examples of my spontaneous sessions (from a deli floor in New York City to a bank teller’s chair in Rome) in previous columns.1-2 Some of you asked me to share yet more tips to deal swiftly with niggling back pains that don’t mask a serious health issue. The following tips can be integrated with most forms of ABT, and as a prelim to needling where appropriate.
The “Frisk” Position
Yes indeed – the receiver is pressed up against the wall, arms and legs outstretched. This is a great way to apply pressure-counterpressure. Involve the receiver in a visual “waterfall” of qi from neck to ankles. Initially, do a “qi sweep” with your flat hands along either side of the spine, and then down the back of each leg so you have a quick insight into UB blocks, distortions or painful areas from neck to ankle.
Repeat a couple of times. Then do a subtle diagonal stretch with one hand on the receiver’s butt, and the other on the opposite shoulder blade.
Return to areas that seem to “call you.” Make a note of any specific back shu point involvements worth discussing with the receiver. That in itself will help ease tension.
Then start thumbing down UB on either side of the spine; or utilize the “pinch” or “squeeze” technique: one hand supporting the lower back, the other “pinching” the UB on either side of the spine between your thumb and the knuckle of your first finger.
This “two-handed” technique, a classic in zen shiatsu, provides harmony between the ”moving” hand and the “listening” hand. Easy to perform. Very comfortable for the receiver. Followed by a simple palming down the legs and finally, a slow pinch of the Achilles, the UB 60 / K 3 area.
UB 36, in the middle of the gluteal fold, zaps lower back pain. Sink your thumbs bilaterally into those points with a slight lifting technique, with your fingers pointed upwards. Also a great way to ease sciatic pain. Pinching the Achilles and applying upward pressure to UB 36 simultaneously is also a great way to ease lower back pain.
Don’t Forget to Ask the Receiver to Stretch!
Between each technique, ask the receiver to step away from the wall to do some simple qi stretches in slow motion. Deep breathing helps throughout, as a lot of folks tend to hold their breath while you work on them, and that’s counterproductive.
Yes, I’ve used the “frisk” position in classrooms, offices, airports, in public during political demonstrations, in cafes, and in clinical practice, especially on clients experiencing computer overload! Often, 10 minutes work like a charm, especially in a crowded or busy situation.
Techniques During Pregnancy or Labor?
When your pregnant client is in the supine position, knees atop a pillow, it’s helpful to reach under her back, keeping your hands flat on the table, fingertips raised to apply pressure down the UB meridian. Her bodyweight does the work.
It’s a very effective technique to give, but remember your hands need to be flat on the futon or table under the receiver at all times so you don’t strain your wrists. .
I have done this successfully in any situation in which the receiver cannot lie in the prone or side positions. I have also performed this hour after hour during a long labor, pausing during contractions, and then continuing before the next contraction. Again, feedback is crucial. In some instances your client might ask you to pause in one section of her back. In other situations she may ask you to keep applying pressure to one point after another.
Side Positioning
Very comfy for folks unable to lie in either prone or supine, and/or/if you also need good access to GB meridians. Make sure the receiver’s upper leg is bent and resting on a pillow for stability. Some receivers also like to hug an additional pillow.
Also a good technique during pregnancy. Great stretch for the lumbar region and a good way to thumb around the sacrum, where we all carry a lot of tension and “pooled” qi.
Stretches in the Side Position
Rest both elbows, palms up, in the middle of the torso and then move your hands apart and swivel your hands around, palms down, to maximize a wonderful side stretch. Repeat a couple of times. Then palm down either side of the spine to enhance qi flow along the UB meridian. Note which back shu points seem to “hold” you, ask you to pause. And communicate with the receiver to gain more information about the specific areas that add relief – or discomfort.
Once the receiver seems more flexible, lean over, cup their knee in your elbow, and rotate the hip. Your opposite hand provides pressure on the sacrum. Bring the knee up as high as possible according to the receiver’s comfort level. And do everything in slow motion.
Chairwork in Public: Don’t Forget to Ask Questions
I recall a moment at an open house when several bodyworkers were giving volunteer chair sessions. A young woman cried out in pain when a teacher started to perform some vigorous wrist-rolling tuina down her back. He’d neglected to ask her some basic questions about injuries, surgeries, chronic problems etc. It turned she had cancer of the spine, but alas, hadn’t said anything.
Even in a public situation, it’s helpful to engage the receiver in simple “backtalk” while running a hand gently down his/her spine. It’s also good to have a demo spine on display (if it’s a school) or at least a colorful anatomy book or open laptop program to discuss both anatomical and acupoint associations.
It’s always helpful to start chairwork with some thumb pressure along the shoulders (pausing in GB 21) and thumbing around the T1-T3 zone to ease upper back tension. Also a great technique to release the first glimmerings of a headache.
Bob the Lawn Guy
When I noticed Bob struggling with his lawn mower, I invited him to my next class so we could work on his back, and demo some useful lifting and movement techniques. I had also noted Bob and his guys quaffing one iced Coke after another while working along the block.
I suggested he fill his cooler with bottled water, flat and sparkling. He did this and included green tea. Within a couple of weeks he told me his back pain had eased and he no longer experienced sugar lows.
Jack and Jill Decide to Buy a New Mattress
Friends of mine were both experiencing back pain, so I offered to make a house call on my way home one evening. I walked into their bedroom and checked their futon.
“Seriously?” I laughed. “You’re sleeping on this lumpy old futon and wonder why you wake up each morning with back pain?” They stared at me.
“But that’s our wonderful college futon!” Jack wailed. “Our first love nest!”
“It saw us through graduate school,” said Jill.
“We can’t just toss it away!” said Jack.
“Compromise?” I suggested. “Convert it into a snug corner loveseat for you and the dogs. Drape it with colorful rugs and cushions. Don’t waste money paying me for shiatsu; treat yourselves to a new futon or mattress instead!”
They did – and were amazed at how quickly their back pains vanished!
Dive more deeply into your subtle body with a yoga nidra practice for the koshas.
According to yogic anatomy (the view of the world that brought us the chakra system), there are five layers of the body and the soul. They are called koshas.
The koshas are interconnected and intimately support one another, and every person has all five koshas within them. One of the best ways to get to know and experience the koshas is through a yoga nidra meditation, which guides us to identify, feel, and relax each part of our body. By bringing attention to each kosha, you can gain a better understanding of how your body and your mind are linked, according to this particular worldview, and gain a better understanding of your own soul.
In order from most physical to most etheric and spiritual, the koshas are:
Annamaya kosha (the physical layer)
Pranamaya kosha (the breath layer)
Manomaya kosha (the mind/belief/emotion layer)
Vijnanamaya kosha (the higher mind/wisdom/intuition layer)
Anandamaya kosha (the bliss/higher consciousness layer)
Annamaya Kosha (the Physical Layer)
The outermost of the koshas is the annamaya kosha, or the physical layer. This includes the entire physical body, including the skin, bones, and blood. Some might believe that the needs of the physical body must be bypassed or ignored in order to experience the soul but, in truth, the physical body is the gateway to entering deeper realms of the mind and heart. Pay homage to this kosha and access deeper layers through eating healthy foods and taking in plenty of water, rest, and relaxation.
Pranamaya Kosha (the Breath Layer)
The pranamaya kosha is named for the Sanskrit word prana, which refers to the lifeforce we receive through excellent food and, primarily, clean, fresh air. This kosha is strengthened through healthy breathing practices such as nadi shodhana (alternate nostril breathing) or dirga pranayama (three-part breath). Many of us take breath for granted—until it’s obstructed. Therefore, keep the nostril passages open and clear through use of a neti pot and/or nasya oil, and get plenty of exercise to keep the lungs strong and healthy.
Manomaya Kosha (the Mind/Belief/Emotion Layer)
Now we enter the layer of the mind, where our imagination and ideas hold the key to unlocking yet deeper layers. This kosha is engaged in acts of creative thinking and active imagination. You strengthen this kosha when you pay attention to the thoughts and beliefs that underlie your actions, as well as when you treat your emotions as messengers and honored guests rather than enemies to be vanquished.
Vijnanamaya Kosha (the Higher Mind/Wisdom/Intuition Layer)
The magic of this layer is revealed when we invest in self-inquiry. The Sanskrit practice called neti, neti (not this, not that) refers to the activity of taking a metaphorical fine-tooth comb through the contents of the mind, ultimately ridding oneself of what no longer serves or benefits. To support this kosha, read books and spiritual texts that stimulate, challenge, and move you to deeper thought. While wisdom cannot be bought, sold, or pretended at, you can engage in practices that awaken your own inner wisdom and surround yourself with people who do the same. Practice trusting your intuition in small ways so that your relationship with it deepens over time.
Anandamaya Kosha (the Bliss/Higher Consciousness Layer)
This kosha is nearest to the soul and as such, is closest to our core essence. This is the home of our innate self, giving rise to a state of being, knowing, and resting in our essential nature. It is experienced only when all the other koshas are relaxed, content, and open.
Below is a 20-minute guided audio meditation to help you bring awareness to each kosha through a practice of deep relaxation called yoga nidra.
Cancer is the second leading cause of death in the United States.1 With advances in cancer screening and treatment, survival rates have increased by 20% over the past 4 decades.2 Despite increased survival rates, quality of life (QoL) is often dramatically diminished due to cancer-related and treatment-related toxicities.3–6
Cancer-related fatigue (CRF) is one of the most pervasive toxicities experienced by survivors.5,7–11 Although most patients experience CRF during treatment, up to 40% of survivors continue experiencing this debilitating fatigue after completion of treatment.12–17 These survivors often report a lack of energy, tiredness, and a need to slow down and rest, which interferes with their ability to work, resume daily routines (eg, walking), and engage in physical activity (PA).6,18
Evidence suggests that yoga alleviates a variety of cancer-induced and treatment-induced toxicities, and could, therefore, improve QoL among cancer survivors.19–32 We previously showed that our yoga intervention, Yoga for Cancer Survivors (YOCAS), effectively improves CRF, insomnia, cognitive impairment, arthralgias, and pain among cancer survivors.33–37 To our knowledge, no nationwide, multicenter, phase III randomized controlled trial (RCT) has studied how reducing CRF through yoga consequently influences CRF’s interference with survivors’ daily activities such as walking and engaging in PA and QoL. Here we report the effect of YOCAS on CRF’s interference with survivors’ walking, PA, and QoL as secondary outcomes from our phase III RCT, and examine whether yoga-induced improvements in CRF mediate changes in CRF’s interference with walking, PA, and QoL among survivors.
Patients and Methods
Study Design
We used data collected from our nationwide, multicenter, phase III RCT (ClinicalTrials.gov identifier: NCT00397930) conducted via the University of Rochester Cancer Center NCI Community Oncology Research Program Research Base (URCC NCORP RB) to examine the effect of YOCAS on CRF’s interference with walking, PA, and QoL (as secondary outcomes) among cancer survivors. The primary and other secondary outcomes along with detailed study design and methods have been published previously.33–37 See supplemental eAppendix 1 (available with this article at JNCCN.org) for information on study recruitment and randomization.
Participants
Participant inclusion criteria included (1) any type of cancer diagnosis, excluding a metastatic diagnosis; (2) completion of primary treatment 2 to 24 months prior to enrollment; (3) persistent sleep disturbance (≥3 on symptom inventory scale); (4) age ≥21 years; and (5) ability to read and understand English. Participants were excluded if they (1) regularly practiced yoga within 3 months or planned to start a new yoga program during the study period; (2) were diagnosed with sleep apnea or metastatic cancer; and (3) were currently receiving any form of cancer treatments except hormonal therapy.
Yoga Intervention
YOCAS is a standardized 4-week yoga intervention that is based on gentle hatha and restorative yoga consisting of breathing exercises, physical alignment postures, and mindfulness exercises.33 Participants in the YOCAS group received 8 yoga sessions (75 minutes per session, twice per week) at low to moderate intensity. Each yoga session was delivered by a Yoga Alliance–registered instructor in a group setting (10–15 participants per group) at community-based sites (eg, community centers, cancer centers, and yoga studios).33
To ensure the standardization, quality, and fidelity of the yoga intervention, each instructor completed a 2-hour training session conducted by the URCC NCORP RB and was instructed to follow the provided intervention manual and a DVD to deliver YOCAS sessions. The study coordinator from each participating NCORP community oncology practice also attended a randomly selected yoga session to observe and verify whether proper content was delivered.
Standard Care Control
Participants in the standard care control group continued their usual follow-up clinic visits with their oncologists and primary care providers. They received the same amount of time and attention from the research team regarding study measures but had no yoga exposure.
Measures
Medical records were reviewed to confirm participants’ eligibility and collect clinical information (eg, cancer type, previous treatment). Demographic data were collected via the study-specific form. Race data were collected using the NCI Clinical Trials Reporting Program criteria for clinical trials. For data reporting purposes, we condensed racial categories to White, Black, and Other (comprising Native Hawaiian or Other Pacific Islander, Asian, American Indian, Alaska Native, and unknown).
Adherence and compliance were monitored by patient-reported daily diaries and yoga attendance logs completed by yoga instructors. A feedback form was used to collect the helpfulness of the YOCAS intervention and whether yoga participants would recommend the intervention to other survivors experiencing similar symptoms. Adverse events were monitored using NCI’s Common Terminology Criteria for Adverse Events and were reported to the URCC Data Safety Monitoring Committee.
CRF’s Interference With Walking, PA, and QoL
The symptom inventory is a commonly used and widely accepted tool for both research and clinical assessments of the severity of symptoms and how symptoms interfere with patients’ daily living.38 We modified the MD Anderson Symptom Inventory and included 12 common symptoms and 8 interference items.36,37 Participants were asked to rate the severity of each symptom on a scale of 0 to 10 (0 = not present; 10 = as bad as you can imagine) and how much their fatigue interfered with the 8 items of their life (including daily living, mood, work, relations with other people, general physical activity, walking, exercise, and quality of life) with a scale of 0 to 10 (0 = did not interfere; 10 = completely interfered). In this study, we used 3 Symptom Inventory interference items to assess CRF’s interference with walking, PA, and QoL. Higher scores indicate worse interference.
CRF
CRF was measured via the Multidimensional Fatigue Symptom Inventory-Short Form (MFSI),39,40 a validated, 30-item, commonly used fatigue instrument that generates a total score indicating overall CRF level and 5 subdomain scores indicating general, physical, emotional, and cognitive fatigue and vigor levels. Higher scores indicate worse fatigue levels. CRF results were previously published.34,37 In this study, the total MFSI scores were used for mediation analysis.
Statistical Analyses
Among 410 participants who consented and were randomized, 328 provided complete baseline and postintervention symptom inventory and MFSI data. A sample size of 328 (YOCAS: n=168; standard care: n=160) provided >90% power to detect an effect size of 0.33 in between-group differences in CRF’s interference with walking, PA, and QoL scores assuming a correlation coefficient of 0.5 between baseline and postintervention at a significance level of 5% with a 2-tailed F test using analysis of covariance (ANCOVA).
Between-group differences in baseline demographic data and characteristics were examined with 2-tailed t tests for continuous variables and chi-square tests for categorical variables. Within-group differences in CRF’s interference with walking, PA, and QoL were assessed using 2-tailed t tests. Between-group intervention effects on CRF’s interference with walking, PA, and QoL at postintervention were assessed using ANCOVA with the intervention arm as the group factor and baseline value as a covariate. Two-tailed t tests and ANCOVA were performed using SAS 9.4 (SAS Institute Inc.). The effect size was calculated using the between-group mean change (postintervention minus baseline) in CRF’s interference with walking, PA, and QoL divided by the standard deviation of baseline scores.
The mediation analysis was conducted using path modeling on change scores in CRF with change scores in CRF’s interference with walking, PA, and QoL as the dependent variables to derive path coefficients. The path modeling included a direct path between the intervention arm (YOCAS vs standard care) and each outcome variable (CRF’s interference with walking, PA, and QoL), a path between the intervention arm and CRF, and a path between CRF and each outcome variable. Statistical significance of mediation was assessed using nonparametric bootstrap 95% confidence intervals for the indirect path coefficient from the intervention arm to each outcome variable on CRF. Statistical significance was determined as P≤.05.
Data analyses followed the intent-to-treat principle and were based on complete cases (see supplemental eAppendix 1 for the description of intent-to-treat, multiple imputation, and mediation analysis).
Results
Figure 1 shows the CONSORT diagram. Among 413 survivors who consented to participate in the study, 3 were excluded due to ineligibility, 410 were randomized to either YOCAS (n=206) or standard care (n=204), 357 provided complete baseline symptom inventory and MFSI data, and 328 provided complete baseline and postintervention symptom inventory and MFSI data. Eighty-one enrolled participants, including 37 YOCAS participants and 44 standard care controls, dropped out of the study due to medical issues (n=12), personal issues (n=47), unknown reasons (n=20), and starting their own yoga program (n=2). One YOCAS participant did not provide complete baseline data. The proportion of dropouts between YOCAS (18%) and standard care (22%) was not significantly different.
Figure 1.
CONSORT diagram.
Abbreviations: MFSI, Multidimensional Fatigue Symptom Inventory; YOCAS, Yoga for Cancer Survivors.
Citation: Journal of the National Comprehensive Cancer Network 21, 2; 10.6004/jnccn.2022.7080
Demographics and Baseline Characteristics
Table 1 shows the demographics and baseline characteristics of 357 participants (YOCAS: n=176; standard care: n=181) who provided complete baseline symptom inventory and MFSI data. Mean [SD] age of participants was 54.3 [10.2] years; most were female (96%), White (93%), married or in a committed relationship (73%), educated at a college level or higher (81%), employed (81%), and breast cancer survivors (77%). Participants had completed surgery (90%), chemotherapy (71%), and/or radiation therapy (67%) prior to enrollment. On average, there was a mean [SD] of 15.7 [8.2] months since their first cancer treatment. No significant between-group differences were found in demographics and baseline characteristics.
Table 1.
Demographics and Baseline Characteristics
Adherence, Compliance, and Adverse Events
YOCAS participants attended an average of 6.5 of 8 prescribed yoga sessions and reported practicing 1 additional session per week on their own. The average rating of exertion was 3.4 on a 0 to 10 scale (with 0 = “nothing at all” and 10 = “very, very strong”), indicating that the intensity of the YOCAS session was low to moderate. YOCAS participants, on average, practiced 182 minutes of yoga each week or 728 minutes across the 4-week intervention period, which was 128 minutes more than the prescribed yoga dose (eight 75-minute sessions = 600 minutes). No significant yoga contamination was found in the standard care group; 7 standard care controls reported an average of 20 minutes of yoga practice weekly during the intervention period. No study intervention–related adverse events were reported.
CRF’s Interference With Walking, PA, and QoL
YOCAS participants reported significant improvements in CRF’s interference with walking (−0.6 ± 0.2; P=.01), PA (−0.9 ± 0.2; P<.01), and QoL (−1.0 ± 0.2; P<.01) from baseline to postintervention, whereas standard care controls reported no change in these outcomes. In addition, ANCOVA revealed significantly greater improvements in CRF’s interference with walking (−0.9 ± 0.3; P<.01; effect size = −0.33; 95% CI, −0.54 to −0.11), PA (−0.9 ± 0.3; P<.01; effect size = −0.33; 95% CI, −0.52 to −0.15), and QoL (−0.9 ± 0.3; P<.01; effect size = −0.33; 95% CI, −0.51 to −0.14) in YOCAS participants than in standard care controls at postintervention, controlling for baseline values (Figure 2, Table 2). More than 90% of YOCAS participants found these changes to be clinically meaningful; they explicitly stated that the YOCAS intervention was helpful and they would recommend it to other survivors for managing these side effects.
Figure 2.
Changes in CRF’s interference with walking, PA, and QoL. Data are presented as effect size and its 95% confidence limits.
Abbreviations: CRF, cancer-related fatigue; PA, physical activity; QoL, quality of life; YOCAS, Yoga for Cancer Survivors.
*P≤.05.
Citation: Journal of the National Comprehensive Cancer Network 21, 2; 10.6004/jnccn.2022.7080
Table 2.
Changes in CRF’s Interference With Walking, Physical Activity, and Quality of Life
Mediational Effect of CRF on CRF’s Interference With Walking
YOCAS participants, compared with standard care controls, reported significantly greater improvements in CRF from baseline to postintervention.34 Mediation analysis revealed that improvements in CRF significantly mediated the intervention effect on CRF’s interference with walking. The path mediation model of CRF and CRF’s interference with walking adjusted with the intervention effect is demonstrated in Figure 3. The total effect of YOCAS compared with standard care on symptom inventory walking interference score was −1.01 points (P<.01), indicating that YOCAS improved CRF’s interference with walking by 1.01 points compared with the effect of standard care on walking. Improvements in CRF significantly mediated the YOCAS effect on CRF’s interference with walking by 0.45 points in addition to the direct YOCAS effect on CRF’s interference with walking of 0.57 points, suggesting that 44% (95% CI, 24%–100%) of the improvements in CRF’s interference with walking was mediated through improvements in CRF.
Figure 3.
Mediational effect of CRF on its interference with walking. Data are presented as regression coefficient ±SE.
Abbreviations: CRF, cancer-related fatigue; YOCAS, Yoga for Cancer Survivors.
*P≤.05.
Citation: Journal of the National Comprehensive Cancer Network 21, 2; 10.6004/jnccn.2022.7080
Mediational Effect of CRF on CRF’s Interference With PA
Mediation analysis revealed that improvements in CRF significantly mediated the intervention effect on CRF’s interference with PA. The path mediation model of CRF and CRF’s interference with PA adjusted with the intervention effect is demonstrated in Figure 4. The total effect of YOCAS compared with standard care on symptom inventory PA interference score was −1.02 points (P<.01), indicating that YOCAS improved CRF’s interference with PA by 1.02 points compared with the effect of standard care on PA. Improvements in CRF significantly mediated the YOCAS effect on improvements in CRF’s interference with PA by 0.54 points in addition to the direct YOCAS effect on CRF’s interference with PA of 0.47 points, suggesting that 53% (95% CI, 34%–100%) of the improvements in CRF’s interference with PA was mediated through improvements in CRF.
Figure 4.
Mediational effect of CRF on its interference with PA. Data are presented as regression coefficient ±SE.
Abbreviations: CRF, cancer-related fatigue; PA, physical activity; YOCAS, Yoga for Cancer Survivors.
*P≤.05.
Citation: Journal of the National Comprehensive Cancer Network 21, 2; 10.6004/jnccn.2022.7080
Mediational Effect of CRF on CRF’s Interference With QoL
Mediation analysis revealed that improvements in CRF significantly mediated the intervention effect on CRF’s interference with QoL. The path mediation model of CRF and CRF’s interference with QoL adjusted with the intervention effect is demonstrated in Figure 5. The total effect of YOCAS compared with standard care on symptom inventory QoL interference score was −0.96 points (P<.01), indicating that YOCAS improved CRF’s interference with QoL by 0.96 points compared with the effect of standard care on QoL. Improvements in CRF significantly mediated the YOCAS effect on improvements in CRF’s interference with QoL by 0.43 points in addition to the direct YOCAS effect on CRF’s interference with QoL of 0.52 points, suggesting that 45% (95% CI, 26%–100%) of the improvements in CRF’s interference with QoL was mediated through improvements in CRF.
Figure 5.
Mediational effect of CRF on its interference with QoL. Data are presented as regression coefficient ±SE.
Abbreviations: CRF, cancer-related fatigue; QoL, quality of life; YOCAS, Yoga for Cancer Survivors.
*P≤.05.
Citation: Journal of the National Comprehensive Cancer Network 21, 2; 10.6004/jnccn.2022.7080
Discussion
To our knowledge, this is the first nationwide, multicenter, phase III RCT demonstrating how reducing fatigue through a standardized, 4-week, yoga intervention (YOCAS) has broader implications on survivors’ daily activities and QoL. Our findings suggest that YOCAS, the gentle hatha and restorative yoga–based, low- to moderate-intensity yoga intervention, practiced 2 to 3 times per week (182 minutes per week; 32–75 minutes per session) for 4 weeks significantly improves CRF’s interference with walking, PA, and QoL among cancer survivors. A significant proportion (44%–53%) of the YOCAS effect on CRF’s interference with walking, PA, and QoL is due to improvements in CRF. By practicing YOCAS, survivors not only reported less CRF but consequently improved their engagement in daily activities such as walking and PA, and overall QoL, suggesting the broader therapeutic impact of yoga on symptom management in cancer survivors.
Although most oncology guidelines41–45 mention that it is reasonable to recommend the use of yoga for treating CRF, compelling level 1/category 1 scientific evidence from multiple blinded phase III RCTs is insufficient to make yoga a gold standard treatment. Results of this study add substantial value to the scientific evidence supporting the use of yoga for treating CRF and its interference with essential daily activities such as walking, PA, and QoL.24–26,28–30,32–37,46–48 In addition, our YOCAS participants demonstrated high adherence and compliance to the yoga intervention, found the yoga intervention helpful, and claimed they would recommend it to other survivors experiencing similar side effects, which underlines the clinically meaningful effect of yoga on symptom management.33 Because these were secondary exploratory analyses, future phase III RCTs designed a priori with CRF and its interference with walking, PA, and QoL as primary outcomes are needed.
Although the results of this study are compelling regarding the use of yoga for treating CRF and its interference with daily activities and QoL, yoga remains underprescribed as an element of supportive care among cancer survivors.49,50 Improving awareness and enhancing accessibility of yoga therapy in cancer care and collaborations with yoga therapists and integrative medicine can lead to dissemination and implementation of yoga therapy in the oncology setting and extension of the benefits of yoga to greater numbers of cancer survivors.50–53 We understand that not all survivors will want to use yoga for treating CRF and other side effects. For those patients, it is reasonable to recommend the use of other behavioral interventions noted in oncology supportive care treatment guidelines (eg, exercise, cognitive behavioral therapy).
Certain limitations should be considered when interpreting our results and developing future studies, including (1) the generalizability of the results: most of our study participants were White, female, educated at a college level or higher, and breast cancer survivors, who do not represent the diversity of the cancer population; (2) the lack of a comparison with an active behavioral placebo: the study design did not compare YOCAS with an active behavioral placebo controlling for subject contact time and attention of the intervention; therefore, we cannot assess whether the improvements in CRF and in CRF’s interference with walking, PA, and QoL are specific to YOCAS; (3) use of only 3 items of the self-reported symptom inventory questionnaire to evaluate CRF’s interference with walking, PA, and QoL might not comprehensively evaluate the true interference level; (4) CRF and the 3 main outcomes were assessed only at baseline and postintervention: this assessment arrangement could not capture temporal changes for mediation analysis and evaluate sustainability of the intervention effect; (5) although compliance with YOCAS was good in this study, the effective dose of yoga might be challenging for survivors with more severe medical, physical, financial, or environmental barriers; and (6) 20% of enrolled participants dropped out due to personal, medical, and other reasons.
Future phase II/III RCTs should consider testing yoga intervention among survivors with diverse demographic backgrounds and various cancer types and treatment histories, and develop strategies to improve participant retention. Comparing yoga intervention to known effective treatments such as exercise or psychosocial interventions for alleviating CRF and its interference with daily activities and QoL could further elucidate the magnitude of each yoga component or their combination (breathing, postures, and mindfulness) versus the active component from other interventions, provide more direct clinical evidence, and identify multiple treatment options for symptom management. Collecting and analyzing objective biophysiologic data and assessing mediational relationships might help reveal the etiologic and pathophysiologic mechanisms of CRF and its connection to survivors’ walking, PA, and QoL. The study of temporal and dose–response relationships can help oncologists and yoga therapists prescribe yoga doses more precisely. Combining yoga with other behavioral interventions can also be considered to elicit greater improvements in CRF and its interference with walking, PA, and QoL among cancer survivors.
Conclusions
Our findings suggest that the standardized 4-week YOCAS yoga program improved CRF’s interference with walking, PA, and QoL among cancer survivors. More importantly, 44% to 53% of the improvements in CRF’s interference with walking, PA, and QoL are attributable to improvements in CRF resulting from yoga. Our findings provide strong clinical evidence for oncologists to include yoga as a treatment option when designing a cancer care plan for survivors experiencing CRF and its interference with walking, PA, and QoL.
Mindfulness is an important part of yoga practice and has been linked to many health benefits.
The popularity of yoga has grown tremendously in the past decade. More than 10 percent of U.S. adults have practiced yoga at some point in their lives. Yoga practitioners spend on average $90 a month, and the yoga industry is worth more than $80 billion worldwide.
Yoga is now a mainstream activity in the U.S. and is commonly portrayed as a healthy lifestyle choice. I am a behavioral scientist who researches how physical activity—and specifically yoga—can prevent and help manage chronic diseases.
Many people attribute improvements in their physical and mental health to their yoga practice. But until recently, research had been sparse on the health benefits of yoga. As the body of rigorous research on yoga grows, more and more work is showing the many health benefits of a yoga practice.
What Is Yoga?
The name “yoga” is derived from the Sanskrit word “Yuj” meaning to unite, join or connect the mind, body, and soul. The first text on yoga was written by the sage Patanjali over 2,000 years ago in India. Patanjali described yoga as “citta-vrtti-nirodhah,” or “stilling the mind.” This was achieved through a mix of breath work, meditation, physical movement, and body purification practices, as well as ethical and moral codes for living a healthy and purposeful life.
Over the years, various yoga teachers have modified the original Patanjali yoga, resulting in different styles that vary in their intensity and focus. For example, some yoga styles such as Vinyasa focus more on intense movements similar to an aerobic workout. Restorative yoga includes more relaxation poses. Iyengar yoga uses props and emphasizes precision and proper alignment of body. These different styles provide options for individuals with different physical abilities.
Generally speaking, yoga instructors in the U.S. today teach styles that incorporate postures, breathing exercises, and sometimes meditation.
As yoga has grown in popularity in recent years, researchers have begun to study its effects and are finding that it has great benefit for mental and physical health.
Yoga involves physical movement, so it is no surprise that most types of yoga can help to improve a person’s strength and flexibility. In one study with healthy untrained volunteers, researchers found that eight weeks of yoga improved muscular strength at the elbow and knee by 10 to 30 percent. Flexibility at the ankle, shoulder, and hip joints also increased by 13 to 188 percent.
Yoga also provides many benefits for mental health. Researchers have found that a regular practice over eight to 12 weeks can lead to moderate reductions in anxiety and depressive symptoms as well as help with stress management.
Yoga mixes physical exercise with meditation and breathing techniques.
More Than Physical Exercise
Yoga is a type of exercise in that it is a form of physical exertion that helps build fitness. A lot of the benefits researchers have found are due to the physical activity component and are similar to benefits from other forms of exercise like running, weightlifting, or calisthenics.
But unlike these other activities, yoga practice incorporates mindfulness as a key aspect. With its focus on controlling breath, holding postures, and meditation, yoga increases how much a person pays attention to the sensations of their body and the present moment. This mindfulness leads to many benefits not found from other forms of exercise.
Studies have shown that mindfulness training on its own can increase a person’s self-awareness, along with the ability to recognize and skillfully respond to emotional stress. It can even give a person greater control over long-term behavior. One study found that increased mindfulness from yoga can help people better recognize and respond to feelings of being full when eating, decrease binge eating, and alleviate concerns over how their body looks.
My colleagues and I observed a similar effect in a pilot study on the benefits of yoga for individuals with Type 2 diabetes. After doing yoga twice a week for three months, several participants reported paying more attention to their diet, snacking less, and eating healthier, even without any nutrition intervention. Our patients also reported less stress and an increased willingness to engage in other types of physical activities.
Yoga is clearly different from Western exercise in how it approaches mental health. With more research, it may be possible to understand the biological mechanisms as well.
Things to Know If You Want to Start Doing Yoga
Yoga may not be helpful for all medical conditions or right for every person, but people of all age groups, body types, and physical abilities can practice yoga. It can be a form of mental and physical exercise for people who do not enjoy sweating during strenuous forms of exercise or for individuals with medical or physical conditions who find working out in the gym challenging.
It is important to consider that although yoga is generally safe, just as with any other form of exercise, there is some risk of getting injured. Individuals with medical conditions who are new to yoga should practice it initially under the supervision of a trained instructor.
If you do decide to give yoga a try, talk to the yoga instructor first to assess whether the style they offer meets your preference and fitness levels. Remember, you may need to practice a couple of weeks to feel the benefits, physically and mentally.
Carrying around extra weight makes one feel heavy and lethargic causing slowness in their movements. Whether for men or for women, it is regarded psychologically that a toned and a fit body can add to the self-confidence quotient greatly.
Through the help of yoga, you can easily shed pounds or kilograms and feel both lighter and younger. When your body is used to physical fitness, it is active and energetic throughout the day. Accumulated fat also makes it harder to carry out many ordinary activities that come up normal like bending or squatting down to pick something off the floor. Abdominal obesity is a real danger when the waist measures 35 inches or more for women and 40 inches for men.
Practice these postures twice a day, once in the morning and later in the evening. Do this for 3-4 weeks consistently to begin seeing the results of your work.
Yoga Guru Himalayan Siddha, Akshar, Founder, Akshar Yoga Research and Development Centre shares 6 yoga asanas for weight loss.
Asanas
Santolanasana Plank Pose
Formation of the posture
Lie on your stomach
Place your palms under your shoulders and lift your upper body, pelvis and knees up
Use your toes to grip the floor and keep the knees straight
Ensure that your knees, pelvis and spine are aligned
Your wrists must be placed exactly below your shoulders with your arms kept straight
Hold the final posture for a while
Vasishtasana
Formation of the posture
Begin with Santholanasan (Plank)
With your left palm firmly on the ground, remove your right hand off the floor
Turn your entire body to face the right side and lift your right leg off the floor and place it over your left leg
Raise your right arm above and keep your fingers pointing to the sky
Ensure that both your knees, heels and feet are in contact with each other
Ensure that both arms and shoulders are in one straight line
Turn your head and look up at your right hand
Hold the asana for a while
Repeat the same on the left side
Hastha Uttanasana Raised-Arms Pose
Formation of the posture
From Pranamasan, raise your joint palms over your head and stretch upward.
Slightly tilt your head, neck and upper back to create a slight arch.
Ensure that your arms are beside your ears as you tilt your upper body back.
Focus your gaze towards the sky.
Padahastasana – Standing Forward Bend Pose
Formation of the Posture
From HasthaUttanasan, exhale and gently bend your upper body down from the hips and tuck your nose in-between your knees.
Place your palms on either side of your feet.
As a beginner, you may have to bend your knees slightly to accomplish this.
With practice, slowly straighten your knees and try to touch your thighs with your chest.
Allow your neck to fall with gravity and tuck your nose in-between your knees
Try to leave as little space between your upper and lower body as possible.
Ensure that your back does not form a hunch.
Naukasana
Formation of the posture
Lie down on your back
Lift up your upper and lower body to balance on your sitting bones.
Your toes must be aligned with your eyes
Keep your knees and back straight
Keep your arms parallel to the ground and pointing forward
Tighten your abdominal muscles
Straighten your back
Inhale and exhale normally
Ek Padasana
Formation of the posture
Begin with Samastithi.
Keep your back straight as you stretch your arms up and join your palms in Pranam.
Exhale and bend your upper body forward and until it is parallel to the floor.
Keep your arms beside your ears. Slowly lift your right leg upwards behind you, keeping it straight.
Your right leg, pelvis, upper body and arms should all form a straight line.
Focus your gaze on a point on the floor to maintain balance.
Along with these yoga asanas, you should definitely make some changes to what you eat. Sufficient sleep at night is another main factor that aids in weight loss. Eliminate stress, and follow a disciplined lifestyle. You can certainly achieve weight loss with a holistic practice like Yoga. The most vital point to remember is that by being regular and consistent with any fitness routine, you can achieve your goal.
The onset of COVID-19 pandemic brought forth several lifestyle trends, as the global focus turned toward fostering physical and mental health and well-being. As people stayed at home and used various strategies to improve their nutrition and fitness, yoga and nutraceuticals came into sharp focus. While consumption of health products such as multivitamins and immunity-boosting drinks surged, Indians also took to the yoga mat to improve agility and endurance through time-tested techniques.
The role of yoga and nutraceuticals in sustaining a healthy lifestyle is also expected to grow as people get busier with a gradual return to pre-pandemic life. On International Yoga Day, June 21, here is expert advice on how to gain the benefits of both of these superhealthy methods:
Be consistent
Healthy minds and bodies require time to develop and consistency to sustain. According to studies, frequent yoga practise can reduce anxiety while also improving heart rate, respiration rate, and blood pressure. Yoga, when practised on a daily basis, helps to grow muscular mass while also maintaining muscle strength and flexibility. Similarly, nutraceuticals, regardless of the purpose — sustained energy levels, bone strength, stronger hair and glowing skin, immunity-boosting and better digestion, or weight loss — only work if taken on a consistent basis, as they seek to fill nutritional deficiencies in one’s diet. It is only when the body is regularly nourished by a combination of diet and supplements that reliable effects can be obtained.
Trust only the experts
Yoga teachers and marketers of nutraceuticals such as pills, capsules, probiotic shots, powders, syrups, and even gummies with both scientifically formulated and natural ingredients are abound in the market. Just as correct posture and knowledge of each yoga asana require research and experience from a yoga master, it is critical to select the ideal makers for your nutraceutical needs. Also, check the labels carefully and avoid anything that claims to be a rapid fix or boasts of a big breakthrough. An expert understands that there are no shortcuts to good health.
One size does not fit all
What asanas and routines worked for your workplace mate may not work for you! If you want to reduce anxiety, you should work with your yoga teacher to add more breathing techniques, such as pranayama, as well as restorative meditation, into your sequence. If you wish to relax tight muscles in your lower back to relieve pain, try a posture combination that includes Dhanurasana (Bow Pose), Bridge Pose, Camel Pose, and Cat and Cow Pose.
To that end, selecting the appropriate nutraceutical based on your personal health goals might boost your wellness quotient. If you want to keep your skin appearing young as you get older, take a collagen supplement on a daily basis. However, for weight loss, a product with a high protein content will be beneficial, depending on other factors such as your total activity level and overall calorie intake.
Treat your body well
In today’s world, a combination of yoga and nutraceuticals can unlock a healthier and fitter life. Busy lifestyles necessitate some corrective action, and both of these low-cost factors can fit seamlessly into daily schedules. However, a word of caution here would be to minimize elements that may endanger the condition of health that these are constructing. Alcohol, smoking, and substance abuse can reverse the benefits of yoga and nutraceutical intake.
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