Guest post by Richard Rawlins

It is 18 years since Health Secretary Alan Milburn launched a scheme for family doctors to prescribe exercise, aerobics, swimming, and yoga for those who are overweight and at risk of strokes, heart disease or suffering from osteoporosis, diabetes or stress. Splendid! But have any benefits resulted? We do not know.

In 2015, Simon Stevens, CEO NHS England, emphasised the importance of NHS staff being cared for: “NHS staff have some of the most critical but demanding jobs in the country. When it comes to supporting the health of our own workforce, frankly the NHS needs to put its own house in order.” He identified “ten leading NHS employers to spearhead a comprehensive initiative to boost NHS staff health at work by committing to ‘six key actions’, including “by establishing and promoting a local physical activity ‘offer’ to staff, such as running, yoga classes, Zumba classes, or competitive sports teams…”

Mr Stevens pointed out that his proposals would cost £5m, but would “help solve the problem of the NHS bill for staff sickness” – then standing at £2.4bn a year.

Good idea. I like to keep fit, and yoga may well help – but is there any evidence it does? Has there been any evaluation of Mr Stevens’ initiative? Has it worked – by any criterion?

More recently, Mr Stevens has climbed aboard the ‘Social Prescribing’ band wagon and declared he would like to see patients provided with yoga, paid for by the NHS.

In January, Health Secretary Matt Hancock announced the need to support a “growing elderly population to stay healthy and independent for longer” with “more social prescribing, empowering people to take greater control and responsibility over their own health through prevention”. And at a ‘Yoga in Healthcare Conference’ in February, Mr Duncan Selbie, chief executive of Public Health England, spoke of extra money promised under the government’s NHS Long Term Plan to fund yoga classes.

Mr Selbie, told doctors and yoga practitioners at the conference: “The evidence is clear … yoga is an evidenced intervention and a strengthening activity that we know works.”

The problem is, Mr Selbie did not provide any evidence in support of his assertions. It is likely there is none. Do not take my word for it – that is the opinion of the US National Center for Complementary and Integrated Health – an institution founded and dedicated to establishing evidence of any benefit from complementary and alternative treatment modalities, and funded to the tune of $164 million p.a.

Promotion for the conference suggested that “The Yoga in Healthcare Alliance (YIHA), the College of Medicine and Integrated Health (CoMIH) and the University of Westminster is collaborating to bridge the worlds of yoga and healthcare with the first ever Yoga in Healthcare Conference.” The YIHA claims it is “working with the NHS to provide yoga to patients.” Its Yoga4Health programme is a 10-week yoga course commissioned by the West London Clinical Commissioning Group, for patients registered at a GP in West London.

In a statement, the YIHA said: “There is significant robust evidence for yoga as an effective ‘mind-body’ medicine that can both prevent and manage chronic health issues and it also delivers significant cost savings to healthcare providers…The College of Medicine will be offering a certificate of attendance to all delegates that can be used towards CPD points.”

On the face of it, that all seems rational and reasonable, but consider, the conference opened with a speech from Dr. Manjunath Nagendra, Chair of the Indian Ministry of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy. AYUSH is an “Indian governmental body purposed with developing, education and research in the field of alternative medicines.”

Now it is one thing to cover the background and history of a therapeutic modality at a conference on yoga, but quite another to give respectful house room to a promoter of anachronistic concepts based on vitalism and having no basis in reality. Good luck to those who believe in vitalism, but why is NHS England involved? Is NHS England content to promote alternative medicine? We should be told – perhaps we should all climb on that bandwagon.

Amongst an array of speakers, most with an interest in having alternative medicine paid for by the NHS, Dr Michael Dixon of the CoMIH, spoke on ‘Social Prescribing and Yoga’ and Drs. Patricia Gerbarg and Richard Brown on “The Therapeutic Power of Breath, a Key Public Health Intervention.”

Inevitably, another enjoying a trip on the bandwagon, is the Prince of Wales. In a written address to the conference he advised: “The ancient practice of yoga has proven beneficial effects on both body and mind…For thousands of years, millions of people have experienced yoga’s ability to improve their lives … The development of therapeutic, evidence-based yoga is, I believe, an excellent example of how yoga can contribute to health and healing. This not only benefits the individual, but also conserves precious and expensive health resources for others where and when they are most needed…I will watch the development of therapeutic yoga in the UK with great interest and very much look forward to hearing about the outcomes from your conference.” The Prince claimed yoga classes had “tremendous social benefits and builds discipline, self-reliance and self-care”, which, he said. contributed to improved general health.

The Prince supplied no evidence to support those assertions. No scientific evidence, no economic evidence such as cost-benefit analyses.

The Prince was “delighted” to discover that the conference was examining the health benefits of yoga and claimed it was “the first of its kind in the UK”. Hardly – there have been many conferences on yoga and health, but the semanticists will hide behind the phrase: “…of its kind” – that is, this was the first UK conference involving the ‘College of Medicine and Integrated Health’ together with representatives of NHS institutions. Semantic sophistry.

Originating in India, the principles and practices of yoga developed as one of the six branches of the Vedas – a Hindu spiritual and ascetic discipline, a part of which, including breath control, simple meditation, and the adoption of specific bodily postures, is now more widely practised for health and relaxation. The word yoga comes from the Sanskrit ‘yug’, meaning to yoke or unite. Not fingers touching toes or noses reaching knees, nor the union of mind and body, although, this is a sense commonly applied within the yoga community. The union that the word yoga is referring to is that of uniting individual consciousness and experience of reality with Divine consciousness – a spiritual state perceived when we quiet our five senses and reconnect with the Supreme Self within. That requires faith.

The concept of yoga is inevitably on the agenda of those who perceive a need to foster ‘integration’ and ‘harmony’ – but as oncological surgeon Dr Mark Crislip has pointed out: “If you integrate fantasy with reality, you do not instantiate reality. If you mix cow pie with apple pie it does not make the cow pie taste better, it makes the apple pie worse.”

Back to reality. Academics from Northumbria University have begun a £1.4m four-year study exploring the impact of yoga on older people with multiple long-term health conditions. In the UK, two-thirds of people aged 65+ have multimorbidity – defined as having two or more long-term health conditions such as diabetes and heart disease.

“Treatments for long-term health conditions account for 70 per cent of NHS expenditure, so researchers want to look at the effectiveness clinically and cost-wise of an adapted yoga programme for older adults with multimorbidity, to reduce reliance on medication.”

Excellent. But for now – the jury is out. Until we do have evidence of the anticipated benefit, we should all bear in mind the view of the Director of the US NICCIH. Commenting on “Yoga for Wellness” Dr Helene Langevin says:

“In a national survey, 94 percent of adults who practiced yoga reported that they did so for wellness-related reasons—such as general wellness and disease prevention or to improve energy – and a large proportion of them perceived benefits from its use. 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.”

But what does the science say? Does yoga actually have benefits for wellness? The NCCIH tells us:

“Only a small amount of research has looked at this topic. Not all of the studies have been of high quality, and findings have not been completely consistent. Nevertheless, some preliminary research results suggest that practicing yoga may help people manage stress, improve balance, improve positive aspects of mental health, and adopt healthy eating and physical activity habits.”

“May help” does not mean “it does help”. And whilst TLC is always lovely, and virtually all interventions “may help relieve stress and improve positive aspects of mental health”, the jury is out as to whether yoga actually does have such benefits. And the NCCIH cites “preliminary research…”. “Preliminary” – after some thousands of years?

Shorn of esoteric metaphysical mishmash, yoga may well assist many patients come to terms with their ailments, but the association of NHS institutions with the CoMIH suggest an agenda to have a wider variety of un-evidenced alternative modalities smuggled into the NHS, contrary to policy that NHS healthcare should be based on evidence. Surely that is to be deprecated. NHS England should explain its endorsement for conferences such as this lest all those who are struggling to advance health care on a rational scientific base pack their bags and go home.

13 Responses to Yoga and the NHS

  • Richard, do you play any instruments or enjoy listening to classical music?

  • Just a minor comment. You got the quote right from Dr. Mark Crislip but he is an infectious disease specialist from the Portland, OR area. It is his fellow Science Based Medicine contributor, Dr. David Gorski who is the cancer surgeon in Detroit. It has been my honor to meet both men and am grateful for their efforts in helping me understand the misleading claims of the SCAM world. I am going to a continuing education lecture on the “natural” treatments from homeopathy. I plan to make a few comments.

  • There you go wanting evidence again, Richard.

    Look, if someone claims sticking needles in my face will make my back feel better, that bear bile would be good for my gall bladder* or that balancing on one hand will bring harmony to my life, I believe them. Why would they lie? It’s called trust, Richard.

    Evidence. Geez.

    *Yes, that really a thing.

  • 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..
    You mentioned the message in your comment:

    “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.”

    EBM is very o.k. when it comes to concrete matters such as diagnostic tools and surgical or orthopedic interventions.

    If I had a skeptical attitude in my life, I would never have such good health as I have now. I had in my life several health issues that are all have been solved with my own self-healing ability through unproven ‘therapies’.

    Let me explain..
    (1) In my adolescence (more than 40 yrs. ago) I often suffered from excess stomach acid..
    On a very good day I read about “acid-balance” in nutrition. And soon after studying the theory I started to use vegetables every main meal and do not eat after 8.00 PM. The symptoms disappeared in a very short time and my energy increased also.

    I was lucky and was just in time because if you do not do anything for a long time with this symptoms, you do need medication because of esophageal abnormalities.

    (2) Between the age 30-35 I began to develop -now and then- heart rhytm disorders and incidental short heart cramps. First I wanted to try a natural way to cure this. I followed a reiki course and began to treat myself very seriously, especially the heart environment.

    The symptoms gradually became less and within 3 months they had completely disappeared. And the symptoms are still completely gone.. (I am almost 65). I still treat the heart environment (10 min. every day) in combination with meditation.

    To the readers I say, use your brains, if a natural way does not help to disappear symptoms, you should ofcourse go to your regular doctor.

    (3)About 15 yrs. ago I discovered the “5 Tibetan Rites”. These are ‘active’ yoga exercises (on Youbube you can see examples) that I still practice every day.. I am very flexible and still have the slim figure as when I was 20..

    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..

    • A correction: (1) “acid balance” is “acid-base balance”

    • @Eelco_G

      I do not see what Yoga has to do specifically with your three examples of improved health issues. For me it is simple lifestyle modifications that helped.

      (1) Dietary modification is the first advice a young person with GERD (Gastro-Esofageal Reflux Disorder) gets from his doctor. Lighter meals, weight control and not eating after dinnertime is exactly what a good doctor would have ordered first, before resorting to medication.

      (2) Periodic/paroxysmal palpitations and chest cramps in this age are usually benign, often stress related and often disappear again later in life, not the least with improvements in lifestyle and stress management. Sounds like that is what helped you.

      (3)Good for you. Doctors always recommend exercise and healthy life style, Yoga is only one of many modalities to achieve that.

    • @ Eelco : Instead of Yoga I prefer 40 minutes walking daily as advised by my doctor for my high cholesterol level + medication. In earlier times, people would do a lot of work in the fields and they were so fit. Nowadays generation do not get any exercise as they sit in one place in front of the computer and work. I see my office colleagues, they just don’t want to walk.

  • I think that the mainstream of a healthy lifestyle is growing intensively and that yoga is definitely not lagging behind it, and most of those who practice yoga will say that there is nothing bad in it, laws will be made soon, funding will become extinct, and much more.

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