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Yoga

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Alternate Name

  • Hatha Yoga

Overview

Hatha yoga, or, as it is commonly called in the US, simply “yoga,” is an exercise system derived from ancient traditions in India. There are many schools or varieties of hatha yoga, but all of them involve “asanas,” or postures. Many asanas function as gentle stretching exercises, increasing flexibility. Others encourage the development of strength and balance.
The practice of hatha yoga goes beyond exercise, however. Special breathing techniques are almost always part of the process; in fact, some forms of yoga focus primarily on breathing, and therefore overlap with traditional breathing practices generally known as pranayama. Because hatha yoga originated in traditional Hindu spiritual practice, it can involve meditation, chanting, as well as philosophical and religious introspection. However, completely secular versions of hatha yoga are widely available.
Hatha yoga is believed by its practitioners to provide benefits above and beyond simple exercise. For example, certain asanas are said to address specific health problems. However, there is only minimal scientific evidence that the practice of hatha yoga actually provides any well-defined medical benefits.

How Is Hatha Yoga Used Today?

There are numerous specific schools of hatha yoga, including Iyengar yoga, Ashtanga yoga, Kriya yoga, Vini yoga, and Bikram yoga, as well as “generic” hatha yoga. Yoga is ordinarily learned through inexpensive group lessons, but regular at-home practice is necessary to progress in skill (and to derive potential health benefits). Lessons are commonly available at hospital wellness centers, health clubs, city recreation departments, and private yoga studios. There are also a wealth of do-it-yourself yoga DVDs and books, but most serious yoga practitioners caution against learning the technique without an instructor present.

What Is the Scientific Evidence for Hatha Yoga?

Although there is some evidence that yoga may offer medical benefits, in general, this evidence is not strong. There are several reasons for this (including funding obstacles), but one is fundamental: Even with the best of intentions, it is difficult to properly ascertain the effectiveness of an exercise therapy like yoga.
Only one form of study can truly prove that a treatment is effective: the double-blind, placebo-controlled trial. However, it isn’t possible to fit yoga into a study design of this type. While it might be possible to design a placebo form of yoga, it would be quite difficult to keep participants and researchers in the dark regarding who is practicing real yoga and who is practicing fake yoga!
Some compromise with the highest research standards is, therefore, inevitable. Unfortunately, the compromise used in most studies is less than optimal. In these trials, yoga has been compared to no treatment. The problem with such studies is that a treatment—any treatment—frequently appears to better than no treatment, due to a host of factors. (See Why Does This Database Rely on Double-blind Studies? for more information.) It would be better to compare yoga to generic forms of exercise, such as daily walking, but thus far this method has not seen much use.
Given these caveats, the following is a summary of what science has found out about the possible medical benefits of yoga.

Possible Benefits of Hatha Yoga

Yoga, like Tai Chi , has been advocated as a means of increasing strength, balance, and physical function in seniors. However, there is as yet little scientific proof that yoga offers such benefits or that it is superior to generic exercises such as walking. There is little doubt that yoga, like any form of stretching, will increase flexibility if it is practiced consistently and over a long period of time. 1
Hatha yoga is also said to relieve tension and stress . In one study of 65 women with depression and/or anxiety, a 2-month yoga program specifically designed to address these emotional conditions significantly reduced anxiety (but not depression) compared to enrolled woman who were waiting for the program to begin. 24 Another study found that participation in a 6-week yoga program was associated with reduced anxiety, depression, and stress in women having radiotherapy for breast cancer. 25 Adding to this evidence, 32 women who had undergone breast cancer surgery were randomized to receive just physical therapy or physical therapy plus a yoga program (called Yoga in Daily Life). 32 At the end of the 3-week trial, the women in the yoga program reported less psychological distress. A trial of 122 healthy pregnant women demonstrated that daily yoga practice incorporating deep relaxation significantly reduced self-perceived stress scores compared to standard prenatal exercises. 27 And lastly, a large 2012 review of 35 studies involving 1,794 people found evidence to support the use of yoga to decrease stress and anxiety, although the overall quality of these studies was poor.35
Weak evidence hints that hatha yoga may offer modest benefits for people with chronic obstructive pulmonary disease (COPD) or asthma.2,3,11,28 For example, in one controlled study, 59 people with mild asthma were randomly assigned to practice yoga and attend a general class or simply to attend the general class. 3 The results showed slight improvements in asthma in the treated group compared to the untreated group. However, even these modest benefits did not last; assessment two months later showed no difference between the groups. Furthermore, as noted above, studies in which the participants in the control group do not receive placebo treatment are inherently unreliable. A small 2009 study of 29 adults with COPD suggests that a 12-week yoga program may be associated with slight improvement in timed walking distance and self-reported functional ability in these patients. 26 A special breathing technique called yogic-style Buteyko breathing may reduce medication use and subjective symptoms, though it does not appear to actually improve lung function. 17,18,19
Yoga has been evalulated for its beneficial effects in a variety of chronically painful conditions, such as low back pain, 12-13migraine headaches,15osteoarthritis.6 In one study, 42 people with carpal tunnel syndrome were randomly assigned to receive either yoga or a wrist splint for a period of 8 weeks.10 The results indicated that use of yoga was more effective than the wrist splint. However, participants in the control group were simply offered the wrist splint and given the choice of using it or not; it would have been preferable for them to have received a more believable placebo, like other forms of meditative exercise. In a small trial involving 53 women with fibromyalgia, those that participated in an 8-week yoga program experienced an improvement in their symptoms, including fatigue, pain, stiffness, and tenderness. 31 In a review of 16 studies, researchers investigated the potential benefits of yoga in improving pain and pain-related disability in a range of conditions, including headache, back pain, irritable bowel syndrome, dialysis, muscle pain, carpal tunnel syndrome, rheumatoid arthritis, and labor pain.34 All of the studies (12 of which were randomized trials) found positive evidence to support the use of yoga.
Yoga had positive effect on chronic low back pain in a randomized trial of 80 patients. Patients randomized to treatment with a yoga program showed improvement in pain, depression, and anxiety symptoms compared to patients in physical therapy. The program was carried out in a residential setting over seven days and included technique, counseling, and educational lectures.36
In a randomized, controlled trial, 8 weeks of daily supervised yoga was modestly more effective than a similar amount of supervised physical exercise in relieving menopausal symptoms (eg, hot flashes), decreasing psychological stress, and improving cognitive abilities among 120 perimenopausal women.21,22
Fatigue is a common side effect of cancer treatment . In one small trial, 31 women who were still experiencing fatigue 6 months after breast cancer treatment were randomized to yoga intervention or health education. 33 On average, those in the yoga group reported feeling less fatigue. At least one study supports yoga's usefulness for congestive heart failure . 23
A small trial involving 54 adolescents with eating disorders found that adding 8 weeks of yoga twice weekly to standard therapy was associated with improved eating disorder-related thoughts and behaviors. 29 Yoga has also been studied for schizophrenia. In one small trial, patients who supplemented their regular treatment with a yoga program lasting 4 months had improved symptoms, were able to function better, and reported a better quality of life compared to those who did physical therapy. 30 To date, only weak evidence has been reported regarding the possible usefulness of yoga for depression,4 and obsessive-compulsive disorder.20
Hatha yoga has also been promoted as a treatment for epilepsy (seizure disorder), but a review of all published scientific trials concluded that there is as yet no meaningful evidence that it is effective. 7
Some evidence suggests that hatha yoga is not helpful for chemical dependency8 or high blood pressure . 9

What to Expect From a Hatha Yoga Class

Yoga classes typically last about 1 to 2 hours. Most of that time is spent practicing various asanas; however, other activities such as breathing exercises may take place as well. Hatha yoga is generally a gentle, nonaerobic form of exercise. However, some types of yoga, such as Iyengar yoga, are more physically vigorous.
By the end of a yoga class, many people report feeling relaxed and comfortable, and consider this a meaningful benefit in itself. However, without regular home practice, it is unlikely that performing yoga will provide any long-term benefit. For this reason, instructors generally encourage daily practice, ranging from a few minutes to an hour or more.

Safety Issues

Hatha yoga is generally at least as safe as any other stretching-based exercise program. However there are a few hatha yoga positions, such as the headstand, that can cause injury when they are performed by a person who isn’t yet sufficiently advanced in yoga, or who has certain health problems, such as a detached retina. A properly qualified instructor can help you avoid injury, taking your own individual health status into account.

References

1 Luskin FM, Newell KA, Griffith M, et al. A review of mind/body therapies in the treatment of musculoskeletal disorders with implications for the elderly. Altern Ther Health Med. 2000;6:46-56.

2 Lewith GT, Watkins AD. Unconventional therapies in asthma: an overview. Allergy. 1996;51:761-769.

3 Manocha R, Marks GB, Kenchington P, et al. Sahaja yoga in the management of moderate to severe asthma: a randomised controlled trial. Thorax. 2002;57:110-115.

4 Janakiramaiah N, Gangadhar BN, Naga Venkatesh Murthy PJ, et al. Antidepressant efficacy of Sudarshan Kriya Yoga (SKY) in melancholia: a randomized comparison with electroconvulsive therapy (ECT) and imipramine. J Affect Disord. 2000;57:255-259.

5 Garfinkel MS, Singhal A, Katz WA, et al. Yoga-based intervention for carpal tunnel syndrome: a randomized trial. JAMA. 1998;280:1601-1603.

6 Garfinkel MS, Schumacher HR Jr, Husain A, et al. Evaluation of a yoga based regimen for treatment of osteoarthritis of the hands. J. Rheumatol. 1994;21:2341-2343.

7 Ramaratnam S, Sridharan K. Yoga for epilepsy. Cochrane Database Syst Rev. 2000;CD001524.

8 Shaffer HJ, LaSalvia TA, Stein JP. Comparing Hatha yoga with dynamic group psychotherapy for enhancing methadone maintenance treatment: a randomized clinical trial. Altern Ther Health Med. 1997;3:57-66.

9 van Montfrans GA, Karemaker JM, Wieling W, et al. Relaxation therapy and continuous ambulatory blood pressure in mild hypertension: a controlled study. BMJ. 1990;300:1368-1372.

10 Garfinkel MS, Singhal A, Katz WA, et al. Yoga-based intervention for carpal tunnel syndrome: a randomized trial. JAMA. 1998;280:1601-1603.

11 Sabina AB, Williams AL, Wall HK, et al. Yoga intervention for adults with mild-to-moderate asthma: a pilot study. Ann Allergy Asthma Immunol. 2005;94:543-548.

12 Williams KA, Petronis J, Smith D, et al. Effect of Iyengar yoga therapy for chronic low back pain. Pain. 2005;115:107-117.

13 Sherman KJ, Cherkin DC, Erro J, et al. Comparing Yoga, Exercise, and a Self-Care Book for Chronic Low Back Pain. A Randomized, Controlled Trial. Ann Intern Med. 2005;143:849-856.

14 Oken BS, Zajdel D, Kishiyama S, et al. Randomized, controlled, six-month trial of yoga in healthy seniors: effects on cognition and quality of life. Altern Ther Health Med. 2006;12:40-47.

15 John PJ, Sharma N, Sharma CM, et al. Effectiveness of yoga therapy in the treatment of migraine without aura: a randomized controlled trial. Headache. 2007;47:654-661.

16 Kjellgren A, Bood SA, Axelsson K, et al. Wellness through a comprehensive Yogic breathing program—A controlled pilot trial. BMC Complement Altern Med. 2007 Dec 19.

17 Cooper S, Oborne J, Newton S, et al. Effect of two breathing exercises (Buteyko and pranayama) in asthma: a randomised controlled trial. Thorax. 2003;58:674-679.

18 Bowler DS, Green A, Mitchell CA. Buteyko breathing techniques in asthma: a blinded randomised controlled trial. MJA. 1998;169:575-578.

19 Cowie RL, Conley DP, Underwood MF, Reader PG. A randomised controlled trial of the Buteyko technique as an adjunct to conventional management of asthma. Respir Med. 2008 Jan 30.

20 Shannahoff-Khalsa DS, Ray LE, Levine S, et al. Randomized controlled trial of yogic meditation techniques for patients with obsessive-compulsive disorder. CNS Spectr. 1999;4:34-47.

21 Chattha R, Raghuram N, Venkatram P, et al. Treating the climacteric symptoms in Indian women with an integrated approach to yoga therapy: a randomized control study. Menopause. 2008 May 6.

22 Chattha R, Nagarathna R, Padmalatha V, et al. Effect of yoga on cognitive functions in climacteric syndrome: a randomised control study. BJOG. 2008 May 22.

23 Pullen PR, Nagamia SH, Mehta PK, et al. Effects of yoga on inflammation and exercise capacity in patients with chronic heart failure. J Card Fail. 2008;14:407-413.

24 Javnbakht M, Hejazi Kenari R, Ghasemi M. Effects of yoga on depression and anxiety of women. Complement Ther Clin Pract. 2009;15:102-4.

25 Vadiraja HS, Raghavendra RM, Nagarathna R, et al. Effects of a yoga program on cortisol rhythm and mood states in early breast cancer patients undergoing adjuvant radiotherapy: a randomized controlled trial. Integr Cancer Ther. 2009;8:37-46.

26 Donesky-Cuenco D, Nguyen HQ, Paul S, Carrieri-Kohlman V. Yoga therapy decreases dyspnea-related distress and improves functional performance in people with chronic obstructive pulmonary disease: a pilot study. J Altern Complement Med. 2009;15:225-34.

27 Satyapriya M, Nagendra HR, Nagarathna R, Padmalatha V. Effect of integrated yoga on stress and heart rate variability in pregnant women. Int J Gynaecol Obstet. 2009;104:218-22.

28 Vempati R, Bijlani RL, Deepak KK. The efficacy of a comprehensive lifestyle modification programme based on yoga in the management of bronchial asthma: a randomized controlled trial. BMC Pulm Med. 2009;9:37.

29 Carei TR, Fyfe-Johnson AL, Breuner CC, et al. Randomized controlled clinical trial of yoga in the treatment of eating disorders. J Adolesc Health. 2010;46(4):346.

30 Duraiswamy G, Thirthalli J, Nagendra HR, Gangadhar BN. Yoga therapy as an add-on treatment in the management of patients with schizophrenia—a randomized controlled trial. Acta Psychiatrica Scandinavica. 2007;116(3):226-232.

31 Carson JW, Carson KM, Jones KD, Bennett RM, Wright CL, Mist SD. A pilot randomized controlled trial of the Yoga of Awareness program in the management of fibromyalgia. Pain. 2010;151(2):530-539.

32 Kovačič T, Kovačič M. Impact of relaxation training according to Yoga In Daily Life system on perceived stress after breast cancer surgery. Integr Cancer Ther. 2011;10(1):16-26.

33 Ganz PA, Irwin MR, Olmstead R, Greendale G, et al. Yoga for persistent fatigue in breast cancer survivors: A randomized controlled trial. Cancer. 2011 Dec 16. [Epub ahead of print]

34 Büssing A, Ostermann T, Lüdtke R, Michalsen A. Effects of yoga interventions on pain and pain-associated disability: a meta-analysis. J Pain. 2012;13(1):1-9.

35 Li AW, Goldsmith CA. The effects of yoga on anxiety and stress. Altern Med Rev. 2012;17(1):21-35.

36 Tekur P, Nagarathna R, Chametcha S. A comprehensive yoga programs improves pain, anxiety and depression in chronic low back pain patients more than exercise: an RCT. Complement Ther Med. 2012;20(3):107-118.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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