Written by Karen Pilkington and the CAM-Cancer Consortium.
Updated August 18, 2015

Yoga

What is it?

The word yoga derives from the Sanskrit root “yuj” which can be translated as to bind or yoke together or a 'union' and refers to the supposed union between mind, body and spirit.1 In its traditional form, yoga practice included moral disciplines in addition to physical exercises and meditation. The eight steps of Classical Yoga are yama or “restraint” or refraining from various vices, niyama or “observance” which includes contentment and tolerance, asana – the postures or physical exercises, pranayama – the breathing techniques, pratyahara which is the preparation of the mind for meditation, dharana –concentration, dhyana - meditation and samadhi or “absorption” - realization of the essential nature of the self.2 Different forms of yoga exist: in the West, the most widely practised form is Hatha yoga, which includes physical postures and exercises to stretch and improve flexibility of the body, breathing exercises, relaxation and meditation.3 Some of the more recently introduced forms of yoga include Iyengar, which is based on Hatha yoga but often makes use of props such as blocks in performing the asanas, Ashtanga or ‘power’ yoga, Vinyasa (‘flowing’ yoga) and Bikram (‘hot’ yoga performed in high temperatures and humidity).4

Application and dosage

Yoga is provided in classes led by a yoga teacher. It can also be practised by the individual having learnt the techniques in a class or from audio-visual resources such as DVDs or instruction books.

History/providers

Yoga originated in Indian culture and in its original form consisted of a complex system of spiritual, moral and physical practices aimed at attaining ‘self-awareness’.3 The ideas surrounding yoga practice were first introduced to the West in the 1890s by a Hindu teacher, Swami Vivekananda, who toured around Europe and the USA.1 Other Indian yoga practitioners followed and, in the 1960s, interest in Hindu spirituality increased. A series of case studies were reported which focused on aspects such as heart rate and blood pressure of yoga practitioners.5 These were followed by early trials of yoga in the control of hypertension.6,7 Psychological aspects of long-term yoga practice were also discussed.8 In the 1980s and 1990s, research published by Dean Ornish, a physician and professor at the University of California, generated further interest in yoga as a therapeutic intervention and component of a lifestyle intervention in heart disease.9,10 By 2004, trials were being conducted of yoga in a range of medical conditions.11 The popularity of yoga has continued to increase, with yoga classes widely available and offering a range of variations on the original practice.12

Claims of efficacy and alleged indications

Yoga is used by people suffering a range of health-related problems as well as to improve general fitness levels.12 Common uses include for the relief of stress, anxiety and depression, for chronic pain and as part of programmes such as mindfulness-based stress reduction used in cancer patients. It is widely promoted as beneficial to physical, psychological and spiritual health.

Mechanisms of action

In general terms, the asanas or stretches involve standing, bending, twisting and balancing the body leading to improved flexibility and strength. Breathing exercises and control help to focus the mind and achieve relaxation while the aim of meditation is to calm the mind.3 The exact mechanism of action is unclear although several theories have been proposed. These include modulation of the stress response systems with consequent reduction in sympathetic tone and catecholamine levels, and reduction in activation of the hypothalamic pituitary axis. It has also been suggested practice of yoga leads to activation of antagonistic neuromuscular systems increasing the relaxation response in the neuromuscular system.3 Meditation is thought to stimulate the limbic system and has been shown to increase blood flow to the brain and the release of endogenous dopamine, and to reduce respiratory rate. One study reported increased levels of GABA, a neurotransmitter, as a result of practising yoga asanas.13

Prevalence of use

Practice of yoga is increasing in prevalence, particularly in the Western world. By 1998, an estimated 15 million adults in the USA had used yoga at least once and over 7 million had used it within the previous year.12 Sixty four per cent used it for wellness and 48% for specific health problems. An increase in prevalence was also demonstrated between 2002 and 2007.14,15 With regard to practice in cancer patients, various figures have been reported: between 1 and 4 % of breast and gynaecological cancer patients in Europe 16,17, no reported use in other cancer patients such as lung and colorectal cancer 18,19 and up to 12 to 18% in cancer patients in the USA.20,21

Legal issues

There is no mandatory regulation of yoga teachers in countries including the USA, Australia and Europe. Regulation of yoga teachers is currently voluntary and is provided through a number of organisations including the Yoga Alliance in the USA and the International Yoga Federation. In the UK, the British Council for Yoga Therapy has worked with the Complementary and Natural Healthcare Council (CNHC) which provides a mechanism for voluntary regulation of yoga therapists.

Costs and expenditures

The cost of yoga classes varies widely with typical costs in Europe (based on costs advertised on the internet in March 2015 for classes in the UK and Germany) of between 5 to 15 Euros per hour.

Citation

Karen Pilkington, CAM-Cancer Consortium. Yoga [online document]. http://cam-cancer.org/The-Summaries/Mind-body-interventions/Yoga. August 18, 2015.

Document history

Fully revised and updated in August 2015 by Karen Pilkington.

Summary first published in June 2013, authored by Karen Pilkington.

References

 

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