Pranayam Count Art Of Living

[Lorna Schildt]

Whethersome forms of yoga are better than others, whether yoga should be prescribed to people for various health conditions, and how yoga compares with other forms of exercise for a good many specific health outcomes. There's also no good evidence behind many of the supposed health benefits of yoga, like flushing out toxins and stimulating digestion.

It's not just me.

The most recent survey suggests more than 20 million Americans practice yoga, making it one of the most popular forms of exercise. Even Vladimir Putin, a devotee of "macho sports," added downward dog to his repertoire.

But is yoga really that great for health compared with other exercises? Does it really help improve our response to stress or correct bad posture, as often promised? Maybe our perceptions about yoga are biased. Or maybe, as some critics have pointed out, there are downsides to yoga. Who can forget the controversial New York Times story from 2012 suggesting that some people get seriously injured, or even die, on their yoga mats.

I wanted a more objective view on the health effects of yoga, so I turned to science, reading more than 50 studies and review articles and talking to seven of the world's leading yoga researchers. Almost immediately, I was struck by how weak the research on yoga is. Most studies were small and badly designed or plagued by self-selection bias. Making matters worse, there are so many varying styles of yoga that it's tough to say how meaningful evidence about one style is for others.

Still, what I learned is that there are a few things we can say about yoga, based on the available research. Yoga probably won't hurt you, despite what haters claim, and it appears to be just as good for your health as other similar forms of exercise.

The first randomized trial (or high-quality experiment) on yoga was published in 1975 in The Lancet. It showed that yoga was more effective than relaxation for reducing high blood pressure. But that trial only involved 34 participants, and all of them already had high blood pressure, so it is difficult to know whether the effect of the yoga would bear out in a larger trial of healthy people.

What studies do exist are often short term. There are no long-term studies on mortality or serious disease incidence. There are few long-term studies on the potential harms yoga can wreak on the body. "For most conditions," says Holger Cramer, director of yoga research at the University of Duisburg-Essen in Essen, Germany, "the main problem is we don't have enough evidence yet."

Studying yoga is also tricky. Researchers generally believe blinded studies are the highest quality of research, because participants involved don't know what intervention (such as a drug) they are receiving and their biases and perceptions don't color the outcomes. But you can't blind people to the fact that they're doing yoga.

Then there's the biggest question at the center of yoga research: How do you define yoga? "Yoga is many things to many people," said Karen Sherman, a researcher affiliated with the Group Health Research Institute. "What you put into a yoga intervention probably impacts what you get out."

Yoga usually involves some combination of the following: postures and poses (asanas), regulated breathing (pranayama), and meditation and relaxation (samyana). But many classes mix in other elements, from chanting to heating to music. There's also a lot of variation in teaching quality and style. Hatha and Iyengar yoga are mostly made up of stretches and restorative poses, while ashtanga and vinyasa tend to be more vigorous and athletic. Yin yoga probably won't make you sweat: You mostly hold postures for long periods of time for very deep stretches. In Bikram, which consists of 26 postures repeated twice in a room that's heated at 105 degrees, you can be sure you'll drench your yoga clothes in perspiration.

Lorenzo Cohen, chief of the integrative medicine section at MD Anderson Cancer Center, told me: "Many papers [on yoga] don't have enough of an in-depth description of what they mean by 'yoga.' What was the level of training of yoga therapists? How did they choose different postures or breathing exercises?"

What's more, there are so many components in a yoga class, it's tough to know what might be having an affect on health: If people report feeling better after a class, was that due to the experience of being part of a larger group? Was it the teacher's style? Was it the breathing exercises? The heat? These factors are difficult to isolate, and some of the ways yoga helps people might be hard for scientists to measure.

Cramer has studied published reports of injuries and other harms from yoga for several review and told me this: "We found yoga is as safe as any other activity. It's not more dangerous than any other form of exercise." He added: "Yoga is not 100 percent safe, but nothing is 100 percent safe."

In a 2013 review of case studies, Cramer identified 76 unique incidents of adverse events from yoga. "Most adverse events affected the musculoskeletal, nervous, or visual system," he concluded. "More than half of the cases for which clinical outcomes were reported reached full recovery, 1 case did not recover at all, and 1 case died."

Most often, people got into trouble with the headstand pose, followed by shoulder stand, postures that required putting one or both feet behind the head, the lotus position, and forceful breathing. Pranayama-, hatha-, and Bikram-style yoga practices had the most adverse events associated with them.

Based on these cases, Cramer and his co-author had this practical advice for how to stay safe in yoga: Beginners should avoid advanced postures (such as headstands), and people with chronic health conditions (such as glaucoma) should consult their doctors before diving in. "Yoga," they added, "should not be practiced while under the influence of psychoactive drugs."

As for long-term yoga harms, Cramer pointed to two studies on joint and cervical disc degeneration in people who have been doing yoga for a while. But the studies had contradictory results, "so long-term health consequences cannot be clearly derived from the available evidence," Cramer said.

I asked MD Anderson's Cohen for his take. "There can, of course, be negative consequences if done incorrectly, like any body manipulation," he said, "but if you have the right teacher this will not happen." Even if a lot of yoga over a lifetime leads to injury, it's not clear those harms outweigh the benefits, or that people would have been better off running or weightlifting all the time.

The short answer is: It depends on the type of yoga. Yoga classes that involve nothing more than lying around on piles of blankets and breathing aren't likely to build your muscles. But more strenuous types of yoga like ashtanga can be surprisingly similar to other forms of vigorous exercise.

The Bikram classes didn't, however, improve the participants' aerobic capacity. Another before-and-after study, published in the Journal of Clinical Nursing, found that hatha yoga could improve aerobic fitness in older people. Still, it's not clear that yoga is ideal here compared with, say, running or swimming.

Considering the mixed findings, a bit of common sense is helpful: If you go to a class mainly focuses on relaxation and doesn't elevate your heart rate, you're probably not getting a good cardio workout or building muscles.

If you go to a more athletic yoga class that tires out your muscles and makes you pant, you can probably count on it helping to make you stronger. If you are panting in a yoga class, you're probably improving aerobic capacity to some extent. That said, if your main goal is building aerobic capacity, you might want to try running or swimming instead of or in addition to yoga.

Karen Pilkington, a research fellow at the University of Westminster, knows this research better than anybody: She sifted through the science for systematic reviews on yoga for both anxiety and depression. (Here's another, more recent systematic review of the evidence on yoga for depression by other authors.)

One complication here: When it comes to conditions like anxiety and depression, it can be difficult to untangle whether it's the yoga that's helping or simply the act of going out, joining a group on a regular basis, and so on. Even if yoga turns out to be unequivocally beneficial for depression, other research has shown that exercise in general can alleviate depression. So, again, it's not clear that yoga is the only way to get this benefit.

Possibly. To be clear, there's currently no direct evidence on yoga's long-term benefits. Researchers simply haven't tracked yogis over a span of 20 years or more and followed up to see whether they get diseases at a lower rate than non-yogis.

But that's not the whole story. There are also some randomized controlled trials suggesting that yoga may improve quality of life for diabetes patients, reduce cardiovascular disease risk factors, and even help people manage high blood pressure

You can think about inflammation in two ways. There's helpful inflammation, as when your body's immune system mounts a response to bacteria in a cut. There's also harmful inflammation. When you're stressed, your body's inflammatory response can go into overdrive, hampering its ability to fight off viruses and disease. People who are inactive, obese, or eat an unhealthy diet have higher levels of harmful inflammation. And researchers have found associations between inflammation and various chronic diseases, including cancer, cardiovascular disease, and diabetes.

Michael Irwin at UCLA's medical school, one of the authors of a 2015 descriptive review on inflammation and mind-body exercises, said, "When you look at the aerobic exercise necessary to decrease inflammation, people have to maintain very vigorous levels." But not with yoga, he continued. "Even practices with minimum levels of physical activity [like Iyengar stretches] can have large effect sizes." Researchers don't yet know why, though they think the meditative components of yoga, tai chi, and meditation may have something to do with it.

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