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  • Evidence based Yoga

    Yoga is a mind and body practice in complementary medicine with origins in ancient Indian philosophy. 
    Carpal tunnel syndrome A randomized, single-blind controlled trial of 42 patients with carpal tunnel syndrome assigned subjects to either a yoga treatment group or a wrist splint group, each 8 weeks in duration. Twice a week, the yoga group practiced postures specifically designed to strengthen and stretch each joint in the upper body. Yoga participants showed improvement in grip strength, pain levels, and Phalen’s sign when compared to the wrist splint group. Nerve conduction studies were not performed.15 A Cochrane review of 21 trials that evaluated the clinical outcome of nonsurgical treatment of carpal tunnel syndrome reported that 8 weeks of yoga practice significantly reduced pain as compared to wrist splinting. The yoga was described as having a “significant short-term benefit,” though the duration of this benefit is unknown.16

    Depression A 2004 review of five RCTs that evaluated yoga-based interventions for depression and depressive disorders showed some positive outcomes and no adverse effects on patients’ mild to severe depressive disorders. However, poor study design and incomplete methodologic reporting makes this interpretation preliminary.17 An RCT studying 7 weeks of yoga training in a group of breast cancer survivors showed positive changes in emotional function, depression, and mood disturbance.18 “Yoga and stress management” (in the online version of this article) provides more information on this study and others involving the effects of yoga on stress.

    Irritable bowel syndrome In an RCT, treatment with loperamide (Imodium) was compared to treatment with a series of 12 yoga postures practiced twice a day for 2 months in a small sample of patients with clinically diagnosed irritable bowel syndrome. Patients underwent measurement of surface electrogastrography, and trait and state anxiety tests were administered before, during, and up to 2 months after treatment. Both intervention groups demonstrated a decrease in bowel symptoms and state anxiety.19

    Menopausal symptoms In a recent pilot study, 14 postmenopausal women reported via interview and questionnaire a decrease in the severity and frequency of hot flushes after 8 weeks of 90-minute “restorative yoga” classes. Although this initial finding sounds encouraging, this trial had no control group or objective parameter measurements.20 An RCT studying postmenopausal sleep quality divided 164 women into groups who participated in either 4 months of low-intensity yoga, a moderate-intensity walking program, or a wait-list control group. This study reported no statistically significant interventional effects of any treatment on total sleep quality or on any individual sleep quality domain.21

    Multiple sclerosis An RCT of 57 subjects with clinically defined multiple sclerosis were assigned to weekly Iyengar yoga class plus home practice, a cycling program, or a wait-list control group for 6 months. Results showed that both active interventions produced significant improvement in perceived levels of energy and reduced fatigue; however, the specific effects of the yoga practice were not isolated.22 Osteoarthritis In a pilot study, 11 deconditioned, yoga naive subjects with a clinical diagnosis of knee osteoarthritis showed improvements in pain and knee stiffness after 8 weeks of yoga training. The group performed modified Iyengar yoga sessions once a week.23

    Seizure disorders In 2000, a systematic review of the published literature revealed that only one study was able to meet the selection criteria for reliable research design. The reviewers concluded that no available evidence pointed to yoga therapy as an efficacious treatment for epilepsy.24
    Strength and flexibility In a recent study on the fitness related effects of hatha yoga, 10 yoga-naïve and previously untrained subjects aged 18 to 27 years participated in 85 minutes of pranayama and hatha yoga practice twice a week for 8 weeks. These subjects showed significant improvement in upper and lower body muscular strength, endurance, and flexibility. No statistically significant change in body composition or pulmonary function was observed.13
    In a partial RCT with a longer time frame, 54 subjects aged 20 to 25 years participated in either 5 months of yoga instruction or no activity. After that time period, both groups practiced yoga for an additional 5 months. The group practicing 10 months of yoga showed significant improvements in shoulder, trunk, hip, and neck flexibility, as well as a reported improved performance during submaximal exercise testing.25
    A well-executed study compared subjects who underwent 24 hours of hatha yoga classes over 8 weeks with a control group. The yoga training group showed a 13% to 35% improvement in flexibility, balance, and muscular endurance. The authors concluded that hatha yoga practice has significant effects on balance and flexibility.26

    REFERENCES

    1. Tindle HA, Davis RB, Phillips RS, Eisenberg DM. Trends in use of complementary and alternative medicine by US adults: 1997-2002. Altern Ther Health Med. 2005;11(1):42-49.
    2. Carrico M. Yoga Journal’s Yoga Basics: The Essential Beginner’s Guide to Yoga for a Lifetime of Health and Fitness. New York, NY: Henry Holt and Company; 1997.
    3. Nayak NN, Shankar K. Yoga: a therapeutic approach. Phys Med Rehabil Clin N Am. 2004;15(4): 783-798, vi.
    4. Innes KE, Bourguignon C, Taylor AG. Risk indices associated with the insulin resistance syndrome, cardiovascular disease, and possible protection with yoga: a systematic review.J Am Board Fam Pract. 2005;18(6):491-519.
    5. Raub JA. Psychophysiologic effects of Hatha yoga on musculoskeletal and cardiopulmonary function: a literature review. J Altern Complement Med. 2002;8(6):797-812.
    6. 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(2): 46-56.
    7. Jensen PS, Kenny DT. The effects of yoga on the attention and behavior of boys with attentiondeficit/ hyperactivity disorder (ADHD). J Atten Disord. 2004;7(4):205-216.
    8. Kirkwood G, Rampes H, Tuffrey V, et al. Yoga for anxiety: a systematic review of the research evidence. Br J Sports Med. 2005;39(12):884-891.
    9. Krisanaprakornkit T, Krisanaprakornkit W, Piyavhatkul N, Laopaiboon M. Meditation therapy for anxiety disorders. Cochrane Database Syst Rev. 2006;(1):CD004998.
    10. 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(5):543-548.
    11. Vendanthan PK, Kesavalu LN, Murthy KC, et al. Clinical study of yoga techniques in university students with asthma: a controlled study. Allergy Asthma Proc. 1998;19(1):3-9.
    12. 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(12):849-856.
    13. Tran MD, Holly RG, Lashbrook J, Amsterdam EA. Effects of Hatha yoga practice on the healthrelated aspects of physical fitness. Prev Cardiol. 2001;4(4):165-170.
    14. Clay CC, Lloyd LK, Walker JL, et al. The metabolic cost of Hatha yoga. J Strength Cond Res. 2005;19(3):604-610.
    15. Garfinkel MS, Singhal A, Katz WA, et al. Yoga-based intervention for carpal tunnel syndrome: a randomized trial. JAMA. 1998;280(18):1601-1603.
    16. O’Connor D, Marshall S, Massy-Westropp N. Nonsurgical treatment (other than steroid injection) for carpal tunnel syndrome. Cochrane Database Syst Rev. 2003(1):CD003219.
    17. Pilkington K, Kirkwood G, Rampes H, Richardson J. Yoga for depression: the research evidence. J Affect Disord. 2005;89(1-3):13-24.
    18. Culos-Reed SN, Carlson LE, Daroux LM, Hately-Aldous S. A pilot study of yoga for breast cancer survivors: physical and psychological benefits. Psycho Oncol. 2006;15(10):891-897.
    19. Taneja I, Deepak KK, Poojary G, et al. Yogic versus conventional treatment in diarrheapredominant irritable bowel syndrome: a randomized control study. Appl Psychophysiol Biofeedback. 2004;29(1):19-33.
    20. Cohen BE, Kanaya AM, Macer JL, et al. Feasibility and acceptability of restorative yoga for treatment of hot flushes: a pilot trial. Maturitas. 2007;56(2):198-204.
    21. Elavsky S, McAuley E. Lack of perceived sleep improvement after 4-month structured exercise programs. Menopause. 2007;14(3, pt 1):535-540.
    22. Oken BS, Kishiyama S, Zajdel D, et al. Randomized controlled trial of yoga and exercise in multiple sclerosis. Neurology. 2004;62(11):2058-2064.
    23. Kolasinski SL, Garfinkel M, Tsai AG, et al. Iyengar yoga for treating symptoms of osteoarthritis of the knees: a pilot study. J Altern Complement Med. 2005;11(4):689-693.
    24. Ramaratnam S, Sridharan K. Yoga for epilepsy. Cochrane Database Syst Rev. 2000(3):CD001524.
    25. Ray US, Mukhopadhyaya S, Purkayastha SS, et al. Effect of yogic exercises on physical and mental health of young fellowship course trainees. Indian J Physiol Pharmacol. 2001;45(1):37-53.
    26. Boehde D, Porcari JP, Greany J, et al. The physiological effects of 8 weeks of yoga training. J Cardiopulm Rehabil. 2005;25(5):290.

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  • light and sight

    “In your light I learn how to love. In your beauty, how to make poems. You dance inside my chest where no-one sees you, but sometimes I do, and that sight becomes this art.”  Rumi

     

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  • Standford Med: Why We Get Fat: Diet Trends and Food Policy

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  • What is Mindfulness?

    What is Mindfulness?

    Mindfulness is a concentrated state of awareness that can help us see and respond to situations with clarity and without getting carried away by emotions or the constant chatter in our heads. Mindfulness enables us to:

    · Better manage tension and stress

    · Enhance objectivity, mental focus

    · Communicate and make decisions more effectively

    · Improve productivity

    · Quiet’s noise in the mind

    Meditation

    Meditation is the tool we use to cultivate mindfulness. With meditation, you intentionally pay attention to a particular object as a way to strengthen concentration. There are thousands of meditative techniques: Tai Chi, yoga, focusing on the breath and using a mantra are all examples. People often think that meditating “correctly” means clearing all thought from the mind. This is a myth. The mind never stops thinking – it’s when we get caught up in our thoughts that we lose mindfulness. By witnessing thoughts, allowing them to pass, and returning to your chosen object of focus, you can actually build the muscle of concentration. Think of meditation as a fitness routine for the mind.

    Are there other benefits to mindfulness?

    In addition to boosting brain power, numerous research studies have shown significant physical benefits including:

    · Reduced blood pressure

    · Lowered cholesterol levels

    · Enhanced immune function

    · Reduced headache, migraine, back pain

    · Improved respiratory function

    Mindfulness does not require a particular set of beliefs in order to learn and practice – it is a quality of mind, accessible and available to all.

    Mindfulness allows us to live every moment fully without the filters of bias, judgment or emotional reaction.

    Mindfulness helps the body cope with physical challenges such as headaches, back pain and even heart disease.

    Mindfulness keeps us from reacting too quickly – it helps increase the gap between impulse and action.

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  • Men and Depression

    In my years f doing groups I have on occasion facilitated men only groups. One issue that comes up is depression. We all have bouts of sadness now and then and when those bouts of sadness interfere with our daily lives than we need to take a step in the direction of change. Below is a handout I often use, particularly with dual diagnosed men.

    Symptoms of Depression

    Not everyone who is depressed or manic experiences every symptom. Some people experience only a few; some people suffer many. The severity of symptoms varies among individuals and also over time.

    · Persistent sad, anxious, or “empty” mood.

    · Feelings of hopelessness or pessimism.

    · Feelings of guilt, worthlessness, or helplessness.

    · Loss of interest or pleasure in hobbies and activities that were once enjoyable

    · Decreased energy, fatigue; feeling “slowed down.”

    · Difficulty concentrating, remembering, or making decisions.

    · Trouble sleeping, early-morning awakening, or oversleeping.

    · Changes in appetite and/or weight.

    · Thoughts of death or suicide, or suicide attempts.

    · Restlessness or irritability.

    · Persistent physical symptoms, such as headaches, digestive disorders, and chronic pain that do not respond to routine treatment.

    Co-Occurrence of Depression with Other Illnesses

    Depression can coexist with other illnesses. In such cases, it is important that the depression and each co-occurring illness be appropriately diagnosed and treated. Research has shown that anxiety disorders which include post-traumatic stress disorder (PTSD), obsessive-compulsive disorder, panic disorder, social phobia, and generalized anxiety disorder commonly accompany depression.

    Substance use disorders (abuse or dependence) also frequently co-occur with depressive disorders. Research has revealed that people with drug and/or alcohol addiction are almost twice as likely to experience depression.

    Depression has been found to occur at a higher rate among people who have other serious illnesses such as heart disease, stroke, cancer, HIV, diabetes, and Parkinson’s.

    Causes of Depression

    Very often, a combination of cognitive, genetic, and environmental factors is involved in the onset of depression. Modern brain-imaging technologies reveal that, in depression, neural circuits responsible for the regulation of moods, thinking, sleep, appetite, and behavior fail to function properly.

    In some families, depressive disorders seem to occur generation after generation; however, they can also occur in people with no family history of these illnesses. Genetics research indicates that risk for depression results from the influence of specific multiple genes acting together with non-genetic factors.

    Environmental factors such as trauma, loss of a loved one, a difficult relationship, financial problem, or any stressful change in life patterns, whether the change is unwelcome or desired, can trigger a depressive episode in vulnerable individuals. Once someone experiences a bout of depression later episodes of depression may occur without an obvious cause.

    Men and Depression

    Men are more likely than women to report alcohol and drug abuse or dependence in their lifetime; however, there is debate among researchers as to whether substance use is a “symptom” of underlying depression in men or a co-occurring condition that more commonly develops in men. Nevertheless, substance use can mask depression, making it harder to recognize depression as a separate illness that needs treatment.

    Instead of acknowledging their feelings, asking for help, or seeking appropriate treatment, men may turn to alcohol or drugs when they are depressed, or become frustrated, discouraged, angry, irritable, and, sometimes, violently abusive. Some men deal with depression by throwing themselves compulsively into their work, attempting to hide their depression from themselves, family, and friends. Other men may respond to depression by engaging in reckless behavior, taking risks, and putting themselves in harm’s way.

    How to Help Yourself if You Are Depressed

    Depressive disorders can make one feel exhausted, worthless, helpless, and hopeless. It is important to realize that these negative views are part of the depression and do not accurately reflect the actual circumstances. Negative thinking fades as treatment begins to take effect. In the meantime:

    • Engage in mild exercise. Go to a movie, a ballgame, or participate in religious, social, AA/NA meetings or other healthy activities.
    • Set realistic goals and assume a reasonable amount of responsibility.
    • Break large tasks into small ones, set some priorities, and what you can as you can.
    • Try to be with other people and to confide in someone; it is usually better than being alone and secretive.
    • Expect your mood to improve gradually, not immediately.
    • Feeling better takes time. Often during treatment of depression, sleep and appetite will begin to improve before depressed mood lifts.
    • Postpone important decisions. Before deciding to make a significant transition–change jobs, get married or divorced–discuss it with others who know you well and have a more objective view of your situation.
    • Do not expect to ‘snap out of’ a depression. But do expect to feel a little better day-by-day.
    • Remember, positive thinking will replace the negative thinking as your depression responds to treatment.
    • Let your family and friends help you.

     

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  • How art aided Andrew Marr’s recovery

    “When I started to recover in hospital, one of my early frustrations was that I found I wanted to draw.
    Drawing does for me what others find in meditation, prayer or gardening. It is my way of connecting to the world; it is not just making images but drinking in and praising what’s around me.
    Returning to the world as I did after my stroke, you look at it with fresh eyes. You want to absorb all you see. That meant being able to draw again and art aided my recovery and charted it.” Read more: http://www.dailymail.co.uk/home/event/article-2442555/BBCs-Andrew-Marr-Knowing-I-able-draw-realise-I-going-OK.html#ixzz2gwenGqUy
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  • If you want

     

    If you want to go fast, go alone. If you want to go far, go with others. African Proverb

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