Archive for December, 2009

Yoga Breathing and Asthma: What the Research Shows and Why You Keep Your Medicine

by on Sunday, December 27th, 2009

Yoga breathing exercises, known as pranayama, are often described as a natural help for asthma. The idea is appealing: slow, controlled breathing could calm the airways. Asthma affects about 300 million people worldwide, according to Cochrane, so it is no surprise that many look for extra help. The research is more cautious than the headlines. Here is what is known, and how to approach it safely if you have asthma.

Can yoga cure asthma?

No. The National Heart, Lung, and Blood Institute states that there is no cure for asthma, but that treatment and an asthma action plan can help you manage it. The plan may include monitoring, avoiding triggers and using medicines. About 1 in 13 people in the United States have asthma. Certain things, such as pollen, exercise, viral infections and cold air, can set off or worsen symptoms. Because exercise itself can be a trigger for some people, anyone with asthma should follow their action plan and keep their quick-relief medicine close at hand when they are active.

What do the studies find?

The best summary comes from a Cochrane review that looked at 15 randomized trials with 1,048 participants. The authors found that yoga probably improves quality of life and asthma symptoms to some extent. However, their confidence in the results is low, because most of the studies were flawed. The effects on lung function were inconsistent, there was a small amount of evidence that yoga can reduce medication usage, and information on unwanted effects was very limited. They concluded that high-quality studies with large numbers of participants are needed. You can read the Cochrane summary for yourself.

What about children?

The National Center for Complementary and Integrative Health reports that a 2020 review of 9 studies with 1,230 children and adolescents found that yoga was associated with improvements in lung function, stress and anxiety, and quality of life. It adds that, because the populations and yoga programs varied so much, it is unclear which parts of yoga and how much of it are needed to provide benefits.

What about older reports of breathing exercises?

You may come across older news stories about small hospital studies in which controlled breathing reduced how irritable the airways were. I could not trace the original study, so I have not relied on it. The reviews above are a better guide, and they suggest a modest benefit as an addition to usual care, not a replacement.

How can you try it safely?

First, never stop or reduce your asthma medicine without your doctor’s advice. Yoga is something to add to your treatment, not instead of it. Second, tell your doctor and your yoga teacher that you have asthma. Third, start with gentle, slow breathing and simple postures. The NCCIH advises people who are new to yoga to avoid forceful breathing and extreme practices, and to learn from a qualified instructor, so skip fast, forceful breathing exercises. Fourth, stop if you cough, wheeze or feel tight and use your quick-relief medicine as your plan says. For poses to begin with, see basic yoga postures and their variations and yoga postures: an introduction, and read how to choose a yoga video for beginners before you pick a video. See also the NHLBI asthma overview.

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No Time for Yoga? How a Few Minutes a Day Can Still Count

by on Sunday, December 6th, 2009

Many people say they would like to try yoga but do not have an hour to spare. The good news is that you do not need one. A few stretches and some slow breathing, done on most days at home or at work, can be a start. This article explains why short sessions are worth doing, how to fit them in, and where their limits lie.

Do short sessions count?

Yes, for general movement. The Physical Activity Guidelines for Americans recommend that adults get at least 150 to 300 minutes of moderate-intensity aerobic activity each week, plus muscle-strengthening activity on at least 2 days. The second edition of the guidelines removed the old requirement that activity be done in bouts of at least 10 minutes, to encourage people to move more often through the day. Gentle yoga is usually lighter work than brisk walking, so it is best seen as an addition to walking or other aerobic exercise. But a few minutes of stretching is a good way to break up long periods of sitting, and the first key guideline for adults is to move more and sit less. You can read the top 10 things to know about the guidelines on the official site.

What can you do in five minutes?

Here is a simple sequence, built from standard yoga and stretching moves rather than any published program. Stand tall and take three slow breaths. Reach both arms overhead, lean gently to one side and then the other. Roll your shoulders back. Bend forward at the hips with soft knees and let your arms hang. Then sit on a chair, turn your upper body gently to each side with a hand on your knee, and finish with a minute of slow breathing, in through the nose and out through the mouth. Harvard Health Publishing advises holding each stretch for about 30 seconds without bouncing, and stopping if you feel pain. Stretching after light activity, when the muscles are warm, works best.

Where can you fit it in?

Think of moments that already exist in your day: after you get out of bed, when the coffee brews, during a break from the computer, or before bed. Our gentle morning routine for beginners is one place to start, and the triangle pose for computer users fits into a work break. Start with just one slot a day and add more only when it feels easy. Short, regular practice is easier to keep up than a plan that needs a free hour.

What are the limits?

Short sessions will not replace a full workout, and a few stretches will not transform your body or cure any condition. NCCIH says yoga is generally safe when done properly, and that the most common injuries are sprains and strains, so do not force a stretch to make up for the small amount of time. People with a health condition, pregnant women and older adults should talk with their provider before beginning. The old post told the story of a yoga teacher who recovered after a serious accident and described her as looking decades younger than her age. I could not verify those claims, so I have not repeated them.

How do you make it last?

Tie the habit to something you already do, keep it short, and be kind to yourself on the days you miss. If you want a bit more, add a walk, which the guidelines count as moderate activity, and take a look at everyday activities that count as moderate exercise. As you gain confidence you can try a longer class, and our introduction to basic yoga postures will help you choose poses.

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Can Lifestyle Changes Reverse Heart Disease? What the Ornish Study Really Showed

by on Friday, December 4th, 2009

In 1990 a small study reported that a strict program of diet and lifestyle changes could make clogged heart arteries narrower, not just stop them from getting worse. It made news around the world. The old version of this post described it in garbled language. Here is what the study actually found, what it did not prove, and what you can safely take from it today.

What did the study find?

The study was the Lifestyle Heart Trial, led by Dr. Dean Ornish and published in The Lancet in 1990. It was a randomized controlled trial, which is the best design for this kind of question. Twenty-eight patients with coronary artery disease were assigned to an intensive lifestyle program (a low-fat vegetarian diet, stopping smoking, stress management training and moderate exercise), and 20 to a usual-care group. After one year, the average narrowing of the arteries (percent diameter stenosis) had regressed from 40.0 to 37.8 percent in the lifestyle group and progressed from 42.7 to 46.1 percent in the usual-care group. Overall, 82 percent of patients in the lifestyle group had an average change toward regression. The abstract in PubMed gives all the numbers.

What did it not prove?

Be careful with this result. The study was very small, with only 48 patients, and it lasted one year. The program had several parts, including the diet, exercise, stress management and no smoking, so the study cannot say which part did the work. The old post said that the researchers could not tell how much of the improvement came from each change, and that is still true. The participants were also strongly committed to a demanding program, which is hard to match in everyday life. And the study does not mean that anyone can safely stop heart medicine. People with heart disease should keep taking prescribed medicines and ask their cardiologist before making big changes.

What do heart experts recommend today?

The National Heart, Lung, and Blood Institute (NHLBI) says that most heart attacks are caused by coronary artery disease, that your age, lifestyle habits and other medical conditions can raise your risk, and that more than 800,000 people in the United States have a heart attack each year, according to the CDC. It also says that heart-healthy living means understanding your risk, making healthy choices and taking steps to reduce your chances of heart disease. The usual advice includes eating a healthy diet, being physically active, not smoking, managing stress, and treating high blood pressure and high cholesterol. See the NHLBI page on heart-healthy living for details.

What can you do in practice?

You do not need a strict program to make a difference. Start with food: our posts on what you can do to lower your cholesterol and what cholesterol is and why too much is a problem explain the basics, and understanding your cholesterol numbers shows how to read a test. Add regular movement with the ideas in health and fitness: why exercise matters. Stress management also has a place, and our article on what the research says about yoga covers the evidence. Talk to your doctor about your own risk and about which of these steps suit you.

When is it an emergency?

Symptoms of a heart attack include chest and upper body pain, shortness of breath, dizziness, sweating and nausea. Women often have different symptoms. NHLBI says that if you think you or someone else may be having a heart attack, you should call 9-1-1 right away, because acting fast can save your life.

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