Many of our patients have anxiety, depression, and a variety of chronic health conditions, all of which can be improved through yoga practice. According to the National Center for Complementary and Integrative Health (NCCIH), 94% of adults who practice yoga do so for improved health and wellness. Yoga is currently one of the top 10 complementary and alternative medicine (CAM) approaches used in the US. In fact, a recent study indicated that at least 31 million American adults have tried yoga. This article discusses the benefits of yoga and implementation strategies for nurses.
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Yoga is a practice that involves and incorporates the body, breath, and mind. It includes a combination of physical postures, muscle stretching, muscle relaxation, balancing, breathing exercises, and meditation. In many cases, yoga can be used with the intention of creating a positive mindset. With regular yoga practice, patients can learn to regulate their breathing, nervous system, and movements.
Yoga isn’t simply moving through a variety of different postures and stretches. When practiced effectively, it incorporates both mind and body. The components of a yoga session include:
* pranayama-breathing exercises
* asana-yoga postures
* systematic relaxation-guided exercises to calm the nervous system
With centering, we ask the patient to pay attention to the breath to help relax the body and decrease stress and inflammatory markers.
Breathing exercises (pranayama) are thought to control the energy in the body to balance the sympathetic and parasympathetic nervous systems. Three breathing exercises that can be completed are victorious breath, alternate nostril breathing, and bee breath. These techniques can be implemented anywhere, including the healthcare setting, and are easy to learn for most individuals, including children (see Yoga for children).
Victorious breath is completed by partially constricting the vocal cords, similar to whispering softly, with the mouth closed while breathing through the nose. Alternate nostril breathing requires blocking one nostril with the thumb, exhaling, and then inhaling. The patient then blocks the other nostril with his or her pinky, exhales, and then inhales. The patient should continue for a few cycles of breath. Bee breath involves covering the eyes and ears and humming on an exhale. The patient uses his or her fingers and thumbs to cover the ears and eyes.
Yoga postures (asana) also include a breathing component. Basically, the patient links postures with breathing. These postures help improve flexibility, strength, and balance. With asana, we encourage the patient to focus on breaths with movement and move with intention.
During systematic relaxation, we want the patient to gain relaxation while remaining awake and aware. The patient can start with breath awareness and a body scan, followed by progressive muscle relaxation.
Lastly, practicing meditation focuses the mind. (For more information on meditation, see “Mindfulness Meditation: Creating Positive Changes in the Brain” from our March/April issue.)
Yoga practice can improve general health and physical, psychological, social, and environmental well-being. Some studies indicate that yoga can prevent cardiovascular diseases, type II diabetes, musculoskeletal diseases, anxiety, and depression. Added benefits of yoga include improved:
* muscle tone
* postural alignment
* cardiovascular fitness
A variety of changes can be seen in the brain after developing a yoga practice, leading to improvements in emotional and mental health. Yoga is associated with increased brain alpha waves, gamma-aminobutyric acid, and serotonin and decreased norepinephrine and cortisol-all of which can increase a sense of relaxation/calm and better mood regulation and decrease stress, anxiety, and signs and symptoms of depression.
Not only does yoga provide mental and emotional benefits, it’s also been shown to provide numerous physiologic benefits, including decreased BP and heart rate and improved cholesterol levels and cardiovascular resilience. Long-term practice of yogic breathing can lead to improvements in autonomic regulation of cardiac function and may decrease the risk of cardiovascular morbidity. In addition, yoga can lead to weight loss with longer and more frequent sessions, dietary components, and home practice.
Yogic breathing can improve lung volumes and be beneficial for patients with chronic lung disorders, such as asthma and chronic obstructive pulmonary disease. Asthma research has shown that yogic breathing can lead to improvements in breathing and quality of life and decreased inhaler use. Yogic breathing can also be used to prevent respiratory complications, such as pneumonia, in the healthcare setting.
For patients with osteoarthritis or rheumatoid arthritis, yoga postures can thicken synovial fluid in the joints, which may decrease pain and protect joints due to increased lubrication and cushioning. Modifications for patients with arthritis, such as folding up a yoga mat to double it under the knees if pain is experienced with kneeling, may need to be made. Yoga enhances posture, which can prevent spinal abnormalities, such as kyphosis (exaggerated curvature of the upper spine) and lordosis (exaggerated curvature of the lower spine).
Yoga has been shown to improve chronic back pain, especially in the lower back and neck. When practiced regularly, yoga may reduce disability associated with back and neck pain. It can also be useful for patients with limited range of motion because it helps loosen joints and improves flexibility and strength.
For patients with overactive bladder or urinary leaking, yoga may help improve symptoms by strengthening weak pelvic floor muscles. It’s also been shown to lessen menopause symptoms for some women, although additional research needs to be conducted for more reliable results.
As a CAM therapy, yoga can be used to replace or complement medications. For example, benzodiazepines are often used to treat anxiety and stress, but can cause unwanted adverse reactions. In some cases, yoga can be used in place of benzodiazepines for patients with anxiety and stress. Because it addresses the physical, psychological, and neurologic components of chronic pain, regular yoga practice may decrease a patient’s need for pain medications. When reviewing the multitude of benefits that yoga offers, it’s easy to see how it can be used as an effective CAM therapy for patients with chronic medical conditions.
Implementing a program
Yoga programs can be implemented in a variety of settings, including hospitals, psychiatric facilities, long-term-care facilities, and schools, to name a few. For example, some cancer treatment centers use yoga as a CAM therapy to increase psychological health.
When implementing a yoga program, a furniture-free room, yoga mats, foam blocks, and blankets may be needed. In general, yoga is considered to be safe; however, in rare instances, injuries such as strains and sprains can occur. To decrease the risk of injury, consider consulting or employing a certified instructor.
It may be beneficial to develop group sessions in addition to sessions that can be completed by individual patients. Group sessions can help patients feel less isolated and alone, providing them with opportunities to connect with others. Individual sessions allow patients to work independently when they wish and, if developed appropriately, can assist the patient to develop an at-home practice.
When helping patients achieve systematic relaxation, an option may be to record a guided session. There are also a variety of apps available that can be downloaded and used for this purpose. E-health relaxation exercises have been shown to improve physical functioning and decrease disability, depression, and anxiety.
One barrier to the implementation of yoga programs is patient perceptions of yoga, including needing a certain body type or level of flexibility. It’s important to remember that yoga can be completed with nearly every type of patient because adaptations are possible. For example, it’s possible to complete a yoga session in a chair or even a hospital bed. It’s also important to understand that for certain medical conditions, such as back pain, yoga practice may need to be adjusted to meet the patient’s needs. Yoga is safe during pregnancy, but alterations may be needed.
When caring for a patient who wishes to start yoga, it’s important to determine his or her reasons for adopting the practice. For example, does the patient want to improve overall health, lose weight, or improve mental health? By knowing your patient’s motivation, you can more effectively provide encouragement and assist him or her on a healthy path (see Patient education).
A positive transformation
Easily and effectively implemented in many healthcare settings and in patient homes, yoga can transform lives by uniting the body, mind, and spirit. It provides a plethora of benefits and has been shown to positively impact quality of life. We can play a role in our patients’ physical and mental/emotional health by learning about yoga and the ways in which it can be implemented in healthcare facilities. Additionally, we can use this knowledge to enhance our own health and happiness.
Yoga for children
In today’s world, children live busy and stressful lives as they attempt to navigate school, social media, sports, and, in some instances, part-time employment. Yoga can help children with self-awareness, self-management, social awareness, and decision-making, improving their ability to maintain calm even in stressful situations, remain attentive, and complete tasks. It’s also been shown to improve psychological well-being, including decreasing anxiety, and can lessen the likelihood of childhood obesity. Yogic breathing may be beneficial for children with asthma and can be completed by most age groups.
When your patient starts yoga, teach him or her to:
* Speak with a healthcare provider if any chronic conditions are present before beginning a yoga program.
* Start slowly; don’t push beyond your comfort level.
* Avoid extreme practices if new to yoga or physically compromised.
* Be aware of the risk of dehydration and overheating.