You don’t know yoga

Dr. Joanna Mills

Did you know that yoga is a more popular physical fitness activity than Australian Rules Football?

In 2015, the Australian Bureau of Statistics reported that 1.7% (317,500) of 11.1 million people age 15 and over who participated in sports and physical exercise did yoga in the 12 months prior compared to 224,000 who played footy.[1] More Australians now do yoga than bushwalking, cricket, or surfing.[1] Although Australian women are eight times more likely to participate in yoga than men,[1] local market research shows that Aussie men in the 25 to 34 age group are the fastest growing segment with 1 in 10 men participating in yoga in 2016, a threefold rise from 2008.[2]

In Australia and internationally, yoga is more popular today than ever before. According to the 2016 Yoga in America Study conducted by Yoga Journal and Yoga Alliance, the number of yoga practitioners has grown exponentially. This study reported that 90% of Americans are familiar with the practice of yoga (up from 75% in 2012), and over a third of Americans report that they are likely to try yoga in the next 12 months.[3] In 2016, 36.7 million Americans participated in a yoga class, more than double the number (15.8 million) in 2008.[3] These rising trends show not only that yoga practice is a global phenomenon but also that there is a burgeoning interest in incorporating yoga into fitness regimes.

Yoga’s star has risen brightly and precipitously. Modern postural yoga as we know it is only a few decades old,[4] with the advent of the yoga mat only transpiring in 1982.[5] In 2017, yoga was most popular among Australians in Generation Y (Gen Y, those born between 1976 and 1990) than any other generation — with 16% of Gen Y doing yoga occasionally or regularly, compared with 11% of Gen X (born between 1961–1975).[6] Moreover, this preference for yoga is most likely driven by positive public perception that “yoga is good for you.”[3] A national survey of yoga in Australia suggested that respondents started practicing yoga for health reasons and believed that yoga improved their specific health or medical condition.[7] Remarkably, a majority of respondents did yoga for mental health issues (i.e. managing stress and anxiety) over musculoskeletal problems.[7]

Whilst most people view yoga as being good for psychological [8] and physical health [9], what is interesting to me is the jury was divided on whether doing yoga is enjoyable. In the Yoga in America Study, there was only a marginal difference in percentages of people who agreed with the statement “I enjoy/enjoyed practicing yoga” compared to those who disagreed (34% vs. 28%). [3] What this suggests to me is that people’s motivations for doing yoga might be driven by perceived health benefits rather than by their preferences. This perhaps implies that people are susceptible to misinformation relating to the ‘natural’ (non-pharmacological) or ‘therapeutic’ powers of yoga.

Yoga means different things to different people. For some, yoga is a spiritual practice or an opportunity for relaxation and reconnection with themselves. For others, it is a form of exercise for keeping fit. All of these motivations are valid and fall under the umbrella of modern yoga culture and practice.[10] However, I feel that as yoga teachers, we should take pains to teach within our scope of practice [11]: to share yoga philosophy, teach safe asana practice, and only advertise the benefits of yoga found in scientific evidence.[12]

Recently, the Cochrane Library* published a Special Collection: Yoga for improving health and well-being, critically evaluating randomised control trials (RCTs) on health-related effects of yoga.[13] These are reviews that synthesize data sets from selected RCTs to identify the overall certainty of evidence.

The Special Collection covered studies on the effects of yoga on people with chronic low back pain, asthma and chronic obstructive pulmonary disease, blood and breast cancer, attention deficit hyperactivity disorder, schizophrenia and epilepsy. It also appraised RCTs studying the use of yoga for preventing cardiovascular disease and preventing repeat cardiac events, reducing the recurrence of abdominal pain in school children, as well as improving balance in older people. These unbiased reviews selected trials with the highest-quality data available to date.

To address concerns of a general population of ‘worried well,’ I will focus on Cochrane reviews relating to enhancing general well-being in healthy adults.

Yoga to manage chronic non-specific lower back pain

Based on data from 12 RCTs including 1080 chronic non-specific lower back pain sufferers, yoga interventions (Iyengar, Hatha, or Viniyoga styles) were found to have small to moderate improvements in back-related function but there were no clinically significant improvements in pain at 3 and 6 months. [14]

Yoga as exercise for reducing fear of falling in older people

Based on 30 randomised and quasi-RCTs, exercise interventions including yoga, were found to reduce the risk and number of falls in 2878 healthy older adults (average age range: 68–85) living in the community who had a fear of falling. These findings suggest that exercise, such as Tai Chi, Qi Gong, dance and yoga, balance or strength and resistance training, performed between 1 to 3 times a week, reduce the fear of falling immediately after a ≤12-week, 13 to 26 week, or 26-week program. However, there were no differences in the benefits of each type of exercise, or yoga in particular.[15]

Yoga to prevent cardiovascular disease

Based on 11 RCTs lasting 3 months, of the 800 adults who were either healthy or at high risk of developing cardiovascular disease (e.g. due to obesity or high blood pressure), people who practiced yoga were found to have slight improvements in diastolic blood pressure readings and mildly elevated high-density lipoprotein (a.k.a. ‘good’) cholesterol levels. Due to the diversity in duration, frequency, and style of yoga used in the studies, the evidence is considered exploratory, of low-quality, and should be used with discretion.[16]

As illustrated by the Cochrane review of RCTs, the impact of yoga tested in the most stringent scientific experiments is scarce. There is limited evidence for the comparative effectiveness of yoga versus other types of exercise. There is no objective data showing that yoga ameliorates musculoskeletal back pain, and only a hint of its role in reducing risk factors for heart disease.

Nonetheless, investigative research on the psychophysiological benefits of yoga in preventing lifestyle-related diseases stemming from chronic stress is ongoing.[17,18,19] As a complement to a healthy lifestyle, including diet and exercise in moderation, yoga is an integrated mind and body movement activity that has the potential to improve muscle strength, flexibility and balance.[13,19] The latter reflects sense of stability and equilibrium derived from inner peace and equanimity in mind, body and spirit as laid out in the Yoga Sutras of Patanjali. The theoretical eight limbs of yoga encompass yogic philosophies of social conduct (yama), personal observances (niyama), postural practice (asana) and breathing exercises (pranayama) on a personal journey towards self-actualisation (samadhi).[20]

There is so much we still don’t know about yoga. Perhaps yoga can augment an approach for developing mind and body awareness. It may help us to sit more comfortably with emotional distress by training basic survival skills in conscious breathing and mindful movement. Through meditation it may guide us to transcend beyond our basic and primal drives — fighting, fleeing, feeding, and sex [21] — representing a form of conscious human evolution.[17]

• Cochrane is a trusted medical research database and a resource used by medical professionals and policy makers globally. It provides high-quality evidence-based findings to inform healthcare decision making for patients and the public.

References

1. Australian Bureau of Statistics. Participation in Sport and Physical Activities, Australia, 2013–14. Cat. 4177.0. Available from http://www.abs.gov.au/ausstats/abs@.nsf/mf/4177.0

2. Roy Morgan Research. Strike a pose: Yoga is the fastest growing fitness activity, Australia, 2016; Article no. 7004. Available from: http://www.roymorgan.com/findings/7004-yoga-is-the-fastest-growing-sport-or-fitness-activity-in-australia-june-2016-201610131055

3. The Yoga in America Study Conducted by Yoga Journal and Yoga Alliance, 2016. Available from: https://www.yogaalliance.org/Portals/0/2016%20Yoga%20in%20America%20Study%20RESULTS.pdf

4. Singleton M. Yoga body: The origins of modern posture practice. New York, NY: Oxford University Press, 2010.

5. Wikipedia. Yoga mat, 2018. Available from: https://en.wikipedia.org/wiki/Yoga_mat

6. Roy Morgan Research. Yoga participation stretches beyond Pilates & Aerobics, 2018; Article no. 7544. Available from: http://www.roymorgan.com/findings/7544-yoga-pilates-participation-december-2017-201803290641

7. Penman S, Cohen M, Stevens P, Jackson S. Yoga in Australia: Results of a national survey. International Journal of Yoga, 2012; 5:92–101.

DOI: https://doi.org/10.4103/0973-6131.98217

8. de Zavala AG, Lantos D. How yoga makes us happy, according to science. Yoga Australia Yoga Today Blog, 2017. Available from: https://blog.yogaaustralia.org.au/how-yoga-makes-us-happy-according-to-science-b665f6210aa6

9. Jordan D. Yoga and the physical body. Yoga Australia Yoga Today Blog, 2017. Available from: https://blog.yogaaustralia.org.au/yoga-and-the-physical-body-cd4d1bebd539

10. Jain, A. Selling Yoga: From Counterculture to Pop Culture. New York, NY: Oxford Scholarship Online, 2014.

11. Yoga Australia. Scope of practice: The role of the yoga teacher. Available from: https://www.yogaaustralia.org.au/scope-of-practice/

12. Ellis N. Why yoga needs a fact check: Is the research reliable? Yoga Australia Yoga Today Blog, 2018. Available from: https://blog.yogaaustralia.org.au/why-yoga-needs-a-fact-check-d29ff93f811b

13. Cochrane Library Special Collection. Yoga for improving health and well-being, 2017. Available from: http://www.cochranelibrary.com/app/content/special-collections/article/?doi=10.1002/14651858.YFIHWB

14. Wieland LS, Skoetz N, Pilkington K, Vempati R, D’Adamo CR, Berman BM. Yoga treatment for chronic non-specific low back pain. Cochrane Database of Systematic Reviews, 2017, Issue 1. Art. No.: CD010671. DOI: 10.1002/14651858.CD010671.pub2.

15. Kendrick D, Kumar A, Carpenter H, et al. Exercise for reducing fear of falling in older people living in the community. Cochrane Database of Systematic Reviews, 2014, Issue 11. Art. No.: CD009848. DOI: 10.1002/14651858.CD009848.pub2.

16. Hartley L, Dyakova M, Holmes J, Clarke A, Lee MS, Ernst E, Rees K. Yoga for the primary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews, 2014, Issue 5. Art. No.: CD010072. DOI: 10.1002/14651858.CD10072.pub2.

17. Telles S, Singh N and IGI Global Online. Research-based perspectives on the psychophysiology of yoga. Hershey, PA: Medical Information Science Reference, 2018. DOI: 10.4018/978–1–5225–2788–6.

18. Cramer H, Sibbritt D, Park CL, Adams J, Lauche R. Is the practice of yoga or meditation associated with a healthy lifestyle? Results of a national cross-sectional survey of 28,695 Australian women. Journal of Psychosomatic Research, 2017; 101:104–109.

DOI: https://doi.org/10.1016/j.jpsychores.2017.07.013

19. Khalsa SBS, Cohen L, McCall T, Telles S. Principles and Practice of Yoga in Health Care. Handspring Publishing, 2016.

20. Patanjali & Shearer, A. The Yoga Sutras of Patanjali. New York: Bell Tower, 2002. Print.

21. Wikipedia. Four Fs (evolution), 2018. Available from: https://en.wikipedia.org/wiki/Four_Fs_(evolution)