Yoga as Medicine

Finding nonpharmacologic methods of improving pain and function is of growing interest among physicians as we navigate appropriate analgesia in the midst of an opioid epidemic. I was intrigued to come across Bennell and colleagues' article discussing unsupervised online yoga as a potential intervention for patients with knee osteoarthritis (1). While the results indicated improved function without improvement in pain after 12 weeks, the improvement did not meet clinical significance, nor was it sustained over a longer period of time.

The interest in yoga as a therapeutic has grown in recent years within “Western” medicine. Its ancient origins, however, are much more complex and expansive than what has become the modern practice of yoga, which focuses mainly on physical postures with incorporated mindfulness. Bennell’s research defines yoga as “low-impact mind–body exercise” (1), a common, oversimplified view of what yoga is today. It leaves out the parts of yoga that focus on ethics, therapeutic breathing, meditation, and personal reflection. I often wonder if the use of the word “yoga” in studies like these is even meaningful—does calling it “yoga” add something new and convincing? Is it better to just call it mind–body exercise? Does doing the latter just co-opt the parts of yoga that people are in fact familiar with? For this study in particular, in which the benefits were not significant or sustained, does this sow doubt about the benefits of yoga that many of its longtime practitioners know anecdotally to be true?

My grandfather is a spiritual man, and he will tell you that Western medicine is doing its best to catch up with what ancient yoga has always known: that meditation, mindfulness, strength and balance, and breath work are essential to maintaining physical and mental health. He does not need any randomized controlled trials to convince him. Those trials that use yoga as an intervention often have oversimplified and incomplete views of what yoga is, which may lead to premature assessments of its benefits. On the flip side, many interventions being studied in modern medicine may not be defined as yoga but may actually fall within the realm of yoga as it has been known for thousands of years—like breath work to reduce blood pressure and heart rate (2) or “mentalizing imagery therapy” to address the stress and mental health of dementia caregivers (3).

Future research that wishes to investigate yoga as a therapeutic should acknowledge the shortcomings of Western definitions and applications of yoga. More deliberate and specific definitions of the yoga that is being studied are prudent to prevent misconceptions of what yoga is and which aspects of it may be helpful in certain disease processes.

References 

1. Bennell KL, Schwartz S, Teo PL, et al. Effectiveness of an unsupervised online yoga program on pain and function in people with knee osteoarthritis. A randomized clinical trial. Ann Intern Med. 2022;175:1345-1355. [PMID: 36122378] doi:10.7326/M22-1761
2. Zou Y, Zhao X, Hou YY, et al. Meta-analysis of effects of voluntary slow breathing exercises for control of heart rate and blood pressure in patients with cardiovascular diseases. Am J Cardiol. 2017;120:148-153. [PMID: 28502461] doi:10.1016/j.amjcard.2017.03.247
3. Yang FC, Zamaria J, Morgan S, et al. How family dementia caregivers perceive benefits of a 4-week mentalizing imagery therapy program: a pilot study. Prof Psychol Res Pr. 2022;53:494-503. [PMID: 36212803] doi:10.1037/pro0000388