Exploring the therapeutic effects of yoga and its ability to increase quality of life

Abstract

The objective of this study is to assess the findings of selected articles regarding the therapeutic effects of yoga and to provide a comprehensive review of the benefits of regular yoga practice. As participation rates in mind-body fitness programs such as yoga continue to increase, it is important for health care professionals to be informed about the nature of yoga and the evidence of its many therapeutic effects. Thus, this manuscript provides information regarding the therapeutic effects of yoga as it has been studied in various populations concerning a multitude of different ailments and conditions. Therapeutic yoga is defined as the application of yoga postures and practice to the treatment of health conditions and involves instruction in yogic practices and teachings to prevent reduce or alleviate structural, physiological, emotional and spiritual pain, suffering or limitations. Results from this study show that yogic practices enhance muscular strength and body flexibility, promote and improve respiratory and cardiovascular function, promote recovery from and treatment of addiction, reduce stress, anxiety, depression, and chronic pain, improve sleep patterns, and enhance overall well-being and quality of life.

Full text

Volume 4 | Issue 2 | July-December | 2011
Official Publication of
Swami Vivekananda Yoga Anusandhana Samsthana University
Online full text at
http://www.ijoy.org.in
IJ YO
International Journal of Yoga
Editorial
Genetics, epigenetics, and pregenetics
Review Article
Exploring the therapeutic effects of yoga and its ability to increase quality of life
Original Articles
Effect of an integrated approach of yoga therapy on quality of life in osteoarthritis of the knee joint: A randomized
control study
Meditation induces a positive response during stress events in young Indian adults
A comparative study of slow and fast suryanamaskar on physiological function
Contents
ISSN 0973-6131

49
International Journal of Yoga  Vol. 4  Jul-Dec-2011
interruption in the stress response, a sense of balance and
union between the mind and body can be achieved.[9]
Yoga is a form of mind-body fitness that involves a
combination of muscular activity and an internally
directed mindful focus on awareness of the self, the
breath, and energy.[4] Four basic principles underlie
the teachings and practices of yoga’s healing system.[6]
The first principle is the human body is a holistic
entity comprised of various interrelated dimensions
inseparable from one another and the health or illness
of any one dimension affects the other dimensions.
The second principle is individuals and their needs are
unique and therefore must be approached in a way that
acknowledges this individuality and their practice must
be tailored accordingly. The third principle is yoga is self-
empowering; the student is his or her own healer. Yoga
engages the student in the healing process; by playing
an active role in their journey toward health, the healing
comes from within, instead of from an outside source
and a greater sense of autonomy is achieved. The fourth
principle is that the quality and state of an individuals
mind is crucial to healing. When the individual has
a positive mind-state healing happens more quickly,
whereas if the mind-state is negative, healing may be
prolonged.
INTRODUCTION
A 3,000 year old tradition, yoga, is now regarded in the
Western world as a holistic approach to health and is
classified by the National Institutes of Health as a form of
Complementary and Alternative Medicine (CAM).[1] The
word “yoga” comes from a Sanskrit root “yuj” which means
union, or yoke, to join, and to direct and concentrate one’s
attention.[2,3] Regular practice of yoga promotes strength,
endurance, flexibility and facilitates characteristics of
friendliness, compassion, and greater self-control, while
cultivating a sense of calmness and well-being.[4,5] Sustained
practice also leads to important outcomes such as changes
in life perspective, self-awareness and an improved sense of
energy to live life fully and with genuine enjoyment.[6-8] The
practice of yoga produces a physiological state opposite
to that of the flight-or-fight stress response and with that
The objective of this study is to assess the ndings of selected articles regarding the therapeutic effects of yoga and to provide
a comprehensive review of the benets of regular yoga practice. As participation rates in mind-body tness programs such
as yoga continue to increase, it is important for health care professionals to be informed about the nature of yoga and the
evidence of its many therapeutic effects. Thus, this manuscript provides information regarding the therapeutic effects of yoga
as it has been studied in various populations concerning a multitude of different ailments and conditions. Therapeutic yoga
is dened as the application of yoga postures and practice to the treatment of health conditions and involves instruction in
yogic practices and teachings to prevent reduce or alleviate structural, physiological, emotional and spiritual pain, suffering
or limitations. Results from this study show that yogic practices enhance muscular strength and body exibility, promote and
improve respiratory and cardiovascular function, promote recovery from and treatment of addiction, reduce stress, anxiety,
depression, and chronic pain, improve sleep patterns, and enhance overall well-being and quality of life.
Key words: Alternative therapy; depression; pain; quality of life; therapeutic yoga.
ABSTRACT
Exploring the therapeutic effects of yoga and its ability to
increase quality of life
Catherine Woodyard
Department of Health, Exercise Science and Recreation Management, The University of Mississippi, The Center for Health Behavior
Research, 215 Turner Center, University, MS, USA
Address for correspondence: Catherine Woodyard,
PO Box 1670, University, MS 38677, USA.
E-mail: cdwoodya@olemiss.edu
Review Article
Access this article online
Website:
www.ijoy.org.in
Quick Response Code
DOI:
10.4103/0973-6131.85485

International Journal of Yoga  Vol. 4  Jul-Dec-2011
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Woodyard: Therapeutic effects of yoga
Yoga philosophy and practice were first described by
Patanjali in the classic text, Yoga Sutras, which is widely
acknowledged as the authoritative text on yoga.[2,6] Today,
many people identify yoga only with asana, the physical
practice of yoga, but asana is just one of the many tools
used for healing the individual; only three of the 196 sutras
mention asana and the remainder of the text discusses the
other components of yoga including conscious breathing,
meditation, lifestyle and diet changes, visualization and
the use of sound, among many others.[6] In Yoga Sutras,
Patanjali outlines an eightfold path to awareness and
enlightenment called ashtanga, which literally means
“eight limbs”.[2,10]
The eight limbs are comprised of ethical principles for living
a meaningful and purposeful life; serving as a prescription
for moral and ethical conduct and self-discipline, they direct
attention towards one’s health while acknowledging the
spiritual aspects of one’s nature. Any of the eight limbs may
be used separately, but within yoga philosophy the physical
postures and breathing exercises prepare the mind and
body for meditation and spiritual development.[4,10] Based
on Patanjali’s eight limbs, many different yogic disciplines
have been developed. Each has its own technique for
preventing and treating disease.[1] In the Western world,
the most common aspects of yoga practiced are the
physical postures and breathing practices of Hatha yoga
and meditation.[4] Hatha yoga enhances the capacity of
the physical body through the use of a series of body
postures, movements (asanas), and breathing techniques
(pranayama). The breathing techniques of Hatha yoga
focus on conscious prolongation of inhalation, breath
retention, and exhalation. It is through the unification
of the physical body, breath, and concentration, while
performing the postures and movements that blockages
in the energy channels of the body are cleared and the
body energy system becomes more balanced. Although
numerous styles of Hatha yoga exist, the majority of studies
included in this manuscript utilized the Iyengar style of
yoga. The Iyengar method of Hatha yoga is based on the
teachings of the yoga master B.K.S. Iyengar.[1] Iyengar yoga
places an emphasis on standing poses to develop strength,
stability, stamina, concentration and body alignment.
Props are utilized to facilitate learning and to adjust poses
and instruction is given on how to use yoga to ease various
ailments and stressors.
Yoga is recognized as a form of mind-body medicine that
integrates an individual’s physical, mental and spiritual
components to improve aspects of health, particularly stress
related illnesses.[8] Evidence shows that stress contributes
to the etiology of heart disease, cancer, and stroke as well
as other chronic conditions and diseases.[11] Due to the
fact that stress is implicated in numerous diseases, it
is a priority to include a focus on stress management
and reduction of negative emotional states in order to
reduce the burden of disease. Viewed as a holistic stress
management technique, yoga is a form of CAM that
produces a physiological sequence of events in the body
reducing the stress response. The scientific study of yoga
has increased substantially in recent years and many
clinical trials have been designed to assess its therapeutic
effects and benefits.
As participation rates in mind-body fitness programs such
as yoga continue to increase, it is important for health
care professionals to be informed about the nature of yoga
and the evidence of its many therapeutic effects. Thus,
this review of the literature is timely and important and
provides information regarding the therapeutic effects of
yoga in various populations concerning a multitude of
different ailments and conditions. Therapeutic yoga is
defined as the application of yoga postures and practice to
the treatment of health conditions.[4] Yoga therapy involves
instruction in yogic practices and teachings to prevent
reduce or alleviate structural, physiological, emotional
and spiritual pain, suffering or limitations. Yogic practices
enhance muscular strength and body flexibility, promote
and improve respiratory and cardiovascular function,
promote recovery from and treatment of addiction, reduce
stress, anxiety, depression, and chronic pain, improve
sleep patterns, and enhance overall well-being and quality
of life.[4,6,12-17]
METHODS
In order to locate research studies and interventions that
examined the therapeutic effects of yoga, databases were
searched through Google Scholar via a universities web
browser. Initially, the following key words were entered
into the database via the advanced search option: “yoga,”
and “therapeutic effects.” This search was conducted to
obtain general information regarding yoga’s therapeutic
effects in the existing literature. Subsequently, a second
search was conducted using the following key words or
exact phrases, “hatha yoga,” “therapeutic effects of yoga,”
“stress,” “anxiety, “depression,” “pain,” and “chronic
disease.” The following criteria were used for including
studies in this review: (1) the article had to be peer
reviewed, (2) published between the years 1990 and 2009,
(3) the intervention had to incorporate some form of yoga
and/ or meditation, and (4) effects of yoga on some outcome
were measured.
In order to select the articles included in this manuscript,
several steps were taken. First, the title was read. If the
article appeared appropriate to the examination of the
therapeutic effects of yoga, it was saved to a folder. The
articles describing interventions that utilized yoga as
a means to achieve some health outcome were chosen

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Woodyard: Therapeutic effects of yoga
for further review. Each of the articles chosen were
then thoroughly read and reviewed. The articles chosen
include a broad spectrum of the benefits, application, and
therapeutic effects of yoga.
RESULTS
Mental health problems such as depression, anxiety,
stress, and insomnia are among the most common reasons
for individuals to seek treatment with complementary
therapies such as yoga.[18] Yoga encourages one to relax,
slow the breath and focus on the present, shifting the
balance from the sympathetic nervous system and the
flight-or-fight response to the parasympathetic system
and the relaxation response.[5] The latter is calming and
restorative; it lowers breathing and heart rate, decreases
blood pressure, lowers cortisol levels, and increases blood
flow to the intestines and vital organs.
One of the main goals of yoga is to achieve tranquility
of the mind and create a sense of well-being, feelings
of relaxation, improved self-confidence, improved
efficiency, increased attentiveness, lowered irritability,
and an optimistic outlook on life.[9] The practice of yoga
generates balanced energy which is vital to the function
of the immune system.[9] Yoga leads to an inhibition of the
posterior or sympathetic area of the hypothalamus. This
inhibition optimizes the body’s sympathetic responses to
stressful stimuli and restores autonomic regulatory reflex
mechanisms associated with stress. Yogic practices inhibit
the areas responsible for fear, aggressiveness and rage, and
stimulate the rewarding pleasure centers in the median
forebrain and other areas leading to a state of bliss and
pleasure. This inhibition results in lower anxiety, heart
rate, respiratory rate, blood pressure, and cardiac output
in students practicing yoga and meditation.[6,13,19,20]
Consistent yoga practice improves depression and can lead to
significant increases in serotonin levels coupled with decreases
in the levels of monamine oxidase, an enzyme that breaks
down neurotransmitters and cortisol.[5] A range of therapeutic
approaches is available for the management of depressive
disorders, but many patients turn to complementary
therapies due to the adverse effects of medication, lack
of response or simply preference for the complementary
approach. A number of studies demonstrate the potential
beneficial effects of yoga interventions on depression,
stress, and anxiety.[18,21,22]
Improved flexibility is one of the first and most obvious
benefits of yoga.[5] With continued practice comes a
gradual loosening of the muscles and connective tissues
surrounding the bones and joints; this is thought to be
one reason that yoga is associated with reduced aches and
pains. Yoga helps to build muscle mass and/ or maintain
muscle strength, which protects from conditions such
as arthritis, osteoporosis and back pain.[6] During a yoga
session, the joints are taken through their full range of
motion, squeezing and soaking areas of cartilage not often
used and bringing fresh nutrients, oxygen and blood to
the area, which helps to prevent conditions like arthritis
and chronic pain.[5] Without proper sustenance, neglected
areas of cartilage will eventually wear out and expose
the underlying bone. Numerous studies have shown that
asana, meditation or a combination of the two reduced
pain in people with arthritis, Carpel Tunnel syndrome,
back pain and other chronic conditions.[5,6,17,23-25] Yoga also
increases proprioception and improves balance.[5]
Yoga increases blood flow and levels of hemoglobin and red
blood cells which allows for more oxygen to reach the body
cells, enhancing their function.[5] Yoga also thins the blood
which can decrease the risk of heart attack and stroke,
as they are often caused by blood clots. Twisting poses
wring out venous blood from internal organs and allow
oxygenated blood to flow in when the twist is released.
Inverted poses encourage venous blood flow from the legs
and pelvis back to the heart and then pumped through
the lungs where it becomes freshly oxygenated. Many
studies show yoga lowers the resting heart rate, increases
endurance, and can improve the maximum uptake and
utilization of oxygen during exercise.[13,20,26] Consistently
getting the heart rate into aerobic range lowers the risk
of heart attack.[5] While not all yoga is aerobic, even yoga
exercises that do not increase heart rate into the aerobic
range can improve cardiovascular functioning.
While yoga is not a cure for a cancer, nor a definitive way
of preventing it, yoga increases physical, emotional and
spiritual wellness, and brings about a certain peace, of
which many cancer patients desire.[27] Yoga, breathing
exercises, and meditation can reduce stress, promote
healing, and enhance quality of life for patients with
cancer.[28,29] The growth of tumors and other cancer
indicators are exacerbated by stress, thus it is especially
important for people with cancer to reduce and manage
stress effectively.[27] Several premises exist as rationale for
applying yoga-based interventions with cancer patients.
Research suggests that yoga can produce an invigorating
effect on mental and physical energy that improves fitness
and reduces fatigue.[28] Additionally, when practicing yoga,
a fundamental emphasis is placed on accepting one’s
moment-to-moment experiences creating mindfulness and
not forcing the body past its comfortable limits. Having
this healthy sense of acceptance is especially important
for individuals dealing with life-threatening illness as
it decreases the stress one experiences from unpleasant
symptomology. Initially, cancer patients likely benefit from
the poses themselves which are designed to exercise each
and every muscle, nerve and gland throughout the body.[27]

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Woodyard: Therapeutic effects of yoga
The postures precisely address the tension, holding, and
blockage of energy in any particular joint or organ. As this
tension is released, energy flows more readily throughout
the body and allows patients to experience a sense of
increased well-being and strength as well as a balance of
mind, body and spirit.
While stimulation is good, too much taxes the nervous
system and yoga provides relief from excess stimulation
and the stressors and hectic nature of modern life.[5]
Restorative postures, savasana, pranayama, and meditation
encourage pratyahara, a turning inward of the senses
which enables downtime for the nervous system, the
byproduct often being improved sleep. Pharmacological
treatment of insomnia is often associated with hazardous
side effects such as states of confusion, psychomotor
performance deficits, nocturnal falls, dysphoric mood,
impaired intellectual functioning and daytime sleepiness,
especially in older adults.[30] Therefore, alternative forms
of therapy for improving sleep are becoming utilized more
frequently. These alternative therapeutic approaches can
be generally classified into three categories: behavioral
based educative methods (e.g. avoiding caffeine or other
stimulants before bedtime), relaxation techniques (e.g.
progressive muscular relaxation, yoga, and meditation)
and formal psychotherapy. Because of its ability to increase
relaxation and induce a balanced mental state, yoga has
been studied to evaluate its possible effects on sleep and
insomnia.[16,30]
In summary, stress has a negative impact on the immune
system and prolonged exposure increases susceptibility to
disease and leads to physical and mental health problems
such as anxiety and depression.[9,19] Practicing yoga and
meditation as a means to manage and relieve both acute
and chronic stress helps individuals overcome other co-
morbidities associated with diseases and leads to increased
quality of life.[14,31] As a non-pharmacological form of
treatment, yoga based interventions are an alternative
option for the treatment of mood disorders. Further
investigation of yoga as a therapeutic intervention in
depressive disorders is needed and future studies should
seek to identify which of the yoga-based interventions is
most effective and what levels of severity of depression
are more likely to respond to this approach.
In addition to the effects of yoga on mood disorders and
stress reduction, yogic practices are shown to improve
cardiorespiratory performance, psychological profile,
and plasma melatonin levels and also significantly
reduced systolic blood pressure, diastolic blood pressure,
mean arterial pressure, and orthostatic tolerance.[16,26]
Furthermore, yoga helps to improve the cardiovascular
efficiency and homeostatic control of the body and results
in improvements in autonomic balance, respiratory
performance, and overall well-being. Yoga based
lifestyle modifications were also shown to aid in
regression of coronary lesions as well as to improve
myocardial perfusion in patients with CAD.[32] Inevitably,
cardiovascular parameters alter as one ages, but these
age-related deteriorations in cardiovascular functions are
slower in persons who practice yoga regularly as yoga
practitioners had lower heart rate as well as lower systolic
and diastolic blood pressure than matched controls.[13]
Numerous studies show that asana, meditation or a
combination of the two can reduce pain and disability
while improving flexibility and functional mobility in
people with a number of conditions causing chronic
pain.[5,6,17,23-25] Additionally, in some cases use of pain
medication was reduced or eliminated completely. Yoga
was also shown to improve gait function and reduce age-
related changes in gait among a group of healthy, non-obese
elders.[33]
Regarding yoga’s effects for cancer patients, results show a
decrease in post-chemotherapy-induced nausea frequency,
nausea intensity, intensity of anticipatory nausea, and
anticipatory vomiting.[29] Additionally, yoga subjects
reported decreased anxiety, depression, and distressful
symptoms and also showed significantly reduced toxicity
scores compared to the controls. Results from another
study showed patients experienced significantly lower
levels of pain and fatigue, and higher levels of invigoration,
acceptance and relaxation following participation in a yoga
intervention.[28] Yoga, breathing exercises, and meditation
can reduce stress, promote healing, increase energy,
decrease adverse treatment effects, and enhance quality-
of-life for patients with cancer.[28,29]
Yoga’s ability to increase relaxation and induce a balanced
mental state was studied to evaluate its effect on sleep
quality and improving insomnia. Regular practice of yoga
resulted in a significant decrease in the time taken to fall
asleep, an increase in the total number of hours slept, and in
the feeling of being rested in the morning.[30] Additionally,
yoga had a positive influence on sleep patterns in
individuals with lymphoma.[16] Furthermore, participation
in yoga classes improved self-reported quality-of-life as
well as measures of physical function among an elderly
population.[14]
According to Buddhist philosophy the roots of addiction
are in the mind and the practice of mindful meditation
encourages addicts to accept the basic impermanence of
human experience and helps them to develop a detached
awareness of thoughts.[12] Yoga and meditation practices
exert positive influence on addictive behaviors. Through
the practice of yoga, addicts shift from self-inflicted harm
and disrespect toward their bodies to more respectful,

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Woodyard: Therapeutic effects of yoga
caring, and loving behaviors. Eating disorders are a
specific type of addiction and yoga appears to be beneficial
in improving body image disturbances and useful in
the recovery from eating disorders.[34] One study found
that female yoga practitioners attribute their positive
feelings and sense of well-being to yoga practice and
report less self-objectification, greater satisfaction with
physical appearance and fewer disordered eating attitudes
compared to non-yoga practitioners.[35]
The findings of the aforementioned studies examining
the psychological and physical outcomes of yoga prove
difficult to summarize and draw concrete conclusions
due to variation in the research designs, differences in the
duration and frequency of yoga classes, and differences in
the specific yoga programs and populations being studied.
Nonetheless, results for the included studies demonstrate
many of the numerous therapeutic effects, benefits and
profound healing power of yoga.
DISCUSSION
Rapidly emerging in the Western world as a discipline for
integrating the mind and body into union and harmony,
when adopted as a way of life, yoga improves physical,
mental, intellectual and spiritual health. Yoga offers an
effective method of managing and reducing stress, anxiety
and depression and numerous studies demonstrate the
efficacy of yoga on mood related disorders.
Currently, treatment for anxiety and depression involves
mostly psychological and pharmacological interventions;
however, mind-body interventions are becoming
increasingly popular as a means to reduce stress in
individuals. Yoga, a form of mind-body exercise, has become
an increasingly widespread therapy used to maintain
wellness, and alleviate a range of health problems and
ailments. Yoga should be considered as a complementary
therapy or alternative method for medical therapy in the
treatment of stress, anxiety, depression, and other mood
disorders as it has been shown to create a greater sense of
well-being, increase feelings of relaxation, improve self-
confidence and body image, improve efficiency, better
interpersonal relationships, increase attentiveness, lower
irritability, and encourage an optimistic outlook on life.
Researchers are only beginning to understand how
disciplines such as yoga promote personal growth, health
and well-being. By acknowledging the unity of mind,
body and spirit, mind-body fitness programs (i.e. yoga)
can assist people in their pursuit of peace, calmness, and
greater wholeness and integration in their lives. Health
care professionals, health educators and the like, need to be
aware of the potential of yoga as an important component
of a personal wellness plan.
While no concrete guidelines exist regarding the frequency
of practice, the more you practice the more you benefit.
Yoga is a personalized practice and as such, frequency and
duration are personal questions with individual answers.
Practice should happen with wisdom and should be
modified to meet individual needs and goals. Individuals
should practice as often as possible, especially in the
beginning. The length of the induction phase will vary
depending on an individual’s initial level of fitness and
health status; the more difficult yoga is for someone in the
beginning the more their body needs it.
While modern medicine has the ability in many cases
to heal physical diseases and alleviate psychological
disorders, it is argued that a purely medical approach is
far less effective in healing the emotional, intellectual, and
personality layers of the human entity. The discipline of
yoga offers individuals a timeless and holistic model of
health and healing and although it may not result in the
complete elimination of physical diseases and/ or adverse
conditions from the body it offers a holistic path of healing.
There exists an indisputable connection between a person’s
overall physical and mental health and the inner peace and
well-being yoga is designed to achieve. Yoga suspends the
fluctuations of the mind and by acting consciously, we live
better and suffer less.
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