MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

A recent blog-post pointed out that the usefulness of yoga in primary care is doubtful. Now we have new data to shed some light on this issue.

The new paper reports a ‘prospective, longitudinal, quasi-experimental study‘. Yoga group (n= 49) underwent 24-weeks program of one-hour yoga sessions. The control group had no yoga.

Participation was voluntary and the enrolment strategy was based on invitations by health professionals and advertising in the community (e.g., local newspaper, health unit website and posters). Users willing to participate were invited to complete a registration form to verify eligibility criteria.

The endpoints of the study were:

  • quality of life,
  • psychological distress,
  • satisfaction level,
  • adherence rate.

The yoga routine consisted of breathing exercises, progressive articular and myofascial warming-up, followed by surya namascar (sun salutation sequence; adapted to the physical condition of each participant), alignment exercises, and postural awareness. Practice also included soft twists of the spine, reversed and balance postures, as well as concentration exercises. During the sessions, the instructor discussed some ethical guidelines of yoga, as for example, non-violence (ahimsa) and truthfulness (satya), to allow the participant to have a safer and integrated practice. In addition, the participants were encouraged to develop their awareness of the present moment and their body sensations, through a continuous process of self-consciousness, keeping a distance between body sensations and the emotional experience. The instructor emphasized the connection between breathing and movement. Each session ended with a guided deep relaxation (yoga nidra; 5–10 min), followed by a meditation practice (5–10 min).

The results of the study showed that the patients in the yoga group experienced a significant improvement in all domains of quality of life and a reduction of psychological distress. Linear regression analysis showed that yoga significantly improved psychological quality of life.

The authors concluded that yoga in primary care is feasible, safe and has a satisfactory adherence, as well as a positive effect on psychological quality of life of participants.

Are the authors’ conclusions correct?

I think not!

Here are some reasons for my judgement:

  • The study was far to small to justify far-reaching conclusions about the safety and effectiveness of yoga.
  • There were relatively high numbers of drop-outs, as seen in the graph above. Despite this fact, no intention to treat analysis was used.
  • There was no randomisation, and therefore the two groups were probably not comparable.
  • Participants of the experimental group chose to have yoga; their expectations thus influenced the outcomes.
  • There was no attempt to control for placebo effects.
  • The conclusion that yoga is safe would require a sample size that is several dimensions larger than 49.

In conclusion, this study fails to show that yoga has any value in primary care.

PS

Oh, I almost forgot: and yoga is also satanic, of course (just like reading Harry Potter!).

 

10 Responses to Is yoga safe and effective in primary care?

  • A therapy (yoga) that promotes circulation and physical flexibility does not really have to be proven; that is
    –throwing money away–! The experiences speak for themselves.

    I invite all the readers to practice the “5 Tibetan Rites” (Youtube) with an empty stomach ;). If you want a better health (more energy and agility!). Let go your skepticism.. You will experience after a short time that I do not speak nonsense..

    Cut from the Guest post of Richard Rawlins:
    “For example, 86 percent said yoga reduced stress, 67 percent said they felt better emotionally, 63 percent said yoga motivated them to exercise more regularly, and 43 percent said yoga motivated them to eat better.”

    Health care must remain affordable, prevention and a more active and conscious lifestyle are important keys to achieving this. Let us not –frustrate– this by a skeptical approach..

  • Dear Edzard, my comment has nothing to do with “back into the dark ages”.

    EBM is very o.k. when it comes to concrete matters such as diagnostic tools and surgical or orthopedic interventions or meds. I repeat the message of Björn Geir (see the recent guest-blog-post) , that I can agree with:
    “Doctors always recommend exercise and healthy life style. Yoga is only one of many modalities to achieve that”.

    • you forgot your axiom:
      “A therapy (yoga) that promotes circulation and physical flexibility does not really have to be proven”

    • @Eelco_G

      Yoga is not more than EBM. EBM is a clearly defined concept, “Yoga” is a diffuse marketing buzzword that does not have any consistently defined meaning. “Yoga” can mean anything the purveyor wants.

      What I said about Yoga only applies to the positive aspects that contributed to help your health problem which only needed more activity and better lifestyle. The esoteric, quasi-religious nonsense that is commonly admixed with “Yoga” products adds nothing of value and only serves to confuse, disturb and defraud.
      Even the exercise can be insensible and damaging. I have seen several cases of destroyed knees and backs from sitting in silly “lotus” position and injuries from trying to tie knots on the body or standing on the head.

  • Björn,

    Regarding safety you certainly have a good point. All activities that people do have risks if you do not practice them in a responsible and careful manner. But compared to other popular activities such as cycling, running, football or just driving a car, you can call yoga a very safe activity ;).

    However, if you are completely unfamiliar with yoga, injuries can occur if, for example, you don’t take lessons and try to learn everything from a book or from a video. There is -no correction-, if you do not perform the exercises properly, it can have unpleasant physical consequences.

    Good information is important, the NHS has it..

    ** >> But yoga is the same as any other exercise discipline – it’s perfectly safe if taught properly by people who understand it and have experience. It’s advisable to learn from a qualified yoga teacher and choose a class appropriate to your level <<.

    ** National Health Service; an extract from "A guide to yoga".

    https://www.nhs.uk/live-well/exercise/guide-to-yoga/

    • the guide states that “most studies suggest yoga is a safe and effective way to increase physical activity…”
      that’s like saying lying down is an effective way to increase rest.

  • Prince Charles has recently promoted a yoga conference that has some very disturbing associations.

    https://webcache.googleusercontent.com/search?q=cache:F6EOLwPehFcJ:https://yogainhealthcarealliance.com/YIHA2019/+&cd=1&hl=en&ct=clnk&gl=uk&client=safari

    An unsurprising collection of quacks and charlatans and, depressingly, Duncan Selby

    Many of these will be known to readers, but I would invite readers to pay special attention to Dr. Sat Bir Singh Khalsa

    He is a member and promoter of the notorious cult 3HO interesting links here
    https://culteducation.com/group/795-3ho.html

    So the me, the question about whether or not yoga is safe is not just about the mechanics of stretchy exercises, it is whether vulnerable patients will be referred to cult promoting quacks via NHS services

  • I kind of agree with everybody here. Even if there’s not yet strong and conclusive evidence, I don’t think practitioners should discard the idea that yoga is safe and effective in most primary care contexts. Certainly, suggesting thoughtful modifications and types of yoga classes can increase efficacy. And certainly, we need to do more research across the board for the potential health benefits of yoga. It doesn’t work for everyone or for every condition, but it does for a lot of different people and toward a lot of different health goals.

  • Yoga is a form of exercise, both to the body and mind. It has the potential to promote well-being as does physical exercise. So, it does have a role in preventive medicine and therefore in primary care. It is true that people make a fortune out of it by creating a business model, especially in the Western, developed countries. But it should not be the reason for not believing in yoga.

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