Pranayama: relearning to breathe

Breathing – what’s the big deal?

Inhale, exhale. That’s a breath. What more is there to know about inhaling and exhaling? You may feel like I’ve got this because we unconsciously and involuntarily take about 20,000 breaths a day. If you feel you’re an expert at breathing because you do it all day long, then I urge you to rethink and relearn. A good start would be to pick up a copy of a book by James Nestor: Breath, the New Science of a Lost Art. Then come to a Tampa Yoga Therapy class and learn pranayama.

Oddly, Nestor doesn’t specifically mention pranayama or even yoga until about the fifth chapter in. Most of his eastern credits go to Buddhism and his personal practice. But after that, he’s all in with an extended bibliography that speaks to one of my favorite topics: Many of the ancient practices of yoga are complementing (and in some cases, outperforming) modern medicine. Of particular note are pranayama and meditation. We are fast-learning the neurophysiology behind these yogic practices of self-regulation.

What does it mean to relearn to breathe?

People are extremely intelligent. But we can be sluggish on system intelligence because our smart body works on autopilot. Those who take the time to study their own systems with acute awareness usually come to rethink and relearn A LOT. Matters not if you lived 5000 years ago, or were born yesterday. It turns out if you pay attention and develop emotional awareness around your autonomic nervous system, you will find your true nature within this “lost art” of breathing.

Your chances of greater breathing skills are improved when guided by an experienced pranayama teacher. With guidance, encouragement, and practice you expand your repertoire of different breathing patterns. You learn different pranayama practices for different effects on the body. For example, to calm down the nervous system you begin to ease into longer periods of holding the breath. Gaining breath holding skills give us  greater control over respiratory and autonomic systems with less exertion and effort.

What does holding my breath have to do with breathing?

Well, nothing! It is a whole, separate topic. But it has everything to do with slowing down your systems and calming your brain. Reducing the number of breaths we take — by holding and slowing, actually improves the functions most affected by our breath patterns. (Note: James Nestor goes in for great detail on oxygen and carbon dioxide exchange with scientific experts in his books and on his website). Learning to slow the breath through retention is literally at the heart of the benefits.

This is especially true as we move into pranayama practices like Anulom Vilom that involve learning the breath retention techniques. With Anulom Vilom there is a slight holding in of the breath at the top of the inhale, and a short holding out of the breath at the bottom of the exhale.

And benefits of relearning to breathe are . . . ?

Reduced stress, less anxiety, better digestion, improved sleep, and a statistically significant decrease in blood pressure in both systolic and diastolic levels, after a few weeks of a regular pranayama practice. Should I continue, or is that list sufficient? Smile. Patterns of inhaling and exhaling in specific pranayama techniques give us back some of the control we need over our “modern” autonomic nervous system. Read modern=out of control.

In therapy sessions and therapeutic yoga classes at Tampa Yoga Therapy, a wide range of pranayama and meditation practices are main components. Some examples are Nadi Shodhana (alternate nostril breathing), Anulom Vilom, the variation that includes breath retention; diaphragmatic breathing, counting breath, and “box breathing” techniques. Once comfortable with Nadi Shodhana, Anulom Vilom, and some of yoga’s basic pranayamas, we can begin extending our pranayama practice to include more repetitions and longer periods of breath holding. Meditation dovetails directly into pranayama. Where the mind goes, the prana flows. We relearn and rethink our way into a more intentional way of being.

References:

Nestor, James, “Breath: the New Science of a Lost Art,” Riverhead Books, May 2020. More at mrjamesnestor.com/breath

Mayank Shukla, Diksha Chauhan, Ritu Raj, “Breathing exercises and pranayamas to decrease perceived exertion during breath-holding while locked-down due to COVID-19 online randomized study,” Complementary Therapies in Clinical Practice, Vol. 41, November 2020

Pooja Agrawal, Abhishek Sinha, Rinku Garg, “Effect of 4 weeks of Pranayama training and 6 min walk test on blood pressure in healthy subjects,” International Journal of Scientific Research, Vol. 9, No. 8, August 2020

Global Yoga Therapy Day – August 14

The following content provided by YogaMate in conjunction with Global Yoga Therapy Day, August 14th. These articles are intended to provide a glimpse into ongoing yoga research projects. Each section addresses specific conditions that may benefit from the practices of yoga therapy.

  1. Introduction to Yoga Therapy

Meditation experience is associated with increased cortical thickness
Lazar. VERY IMPORTANT RESEARCH ON BRAIN CHANGES AND MEDITATION. Meditation is associated with increased cortical thickness, a positive indicator of brain health and function.

Benefits of Yoga (with Links to Research)
Nice infographic

Relaxation Response Can Influence Expression Of Stress-related Genes
“How could a single, nonpharmacological intervention help patients deal with disorders ranging from high blood pressure, to pain syndromes, to infertility, to rheumatoid arthritis? That question may have been answered by a study finding that eliciting the relaxation response — a physiologic state of deep rest — influences the activation patterns of genes associated with the body’s response to stress.”

Yoga and the Brain what Neuroscience can tell us
Your brain on yoga – easy physiology

Scope of Practice for Yoga Therapy
What is the scope of practice for a Yoga Therapist?  What can they do and not do? The International Association of Yoga Therapists lays this all out nicely in this chart.  Yoga Therapist renewing their certification must pass a quiz on this information.

 

  1. Chronic Pain

A Pragmatic Multicentered Randomized Controlled Trial of Yoga for Chronic Low Back Pain:  Economic Evaluation
Specialized group yoga classes are likely to be cost-effective in improving recurrent lower-back pain.

Brain Mechanisms Supporting the Modulation of Pain by Mindfulness Meditation
“After 4 days of mindfulness meditation training, meditating in the presence of noxious stimulation significantly reduced pain unpleasantness by 57% and pain intensity ratings by 40% when compared to rest.” This study also explored the impact of the practice of mindfulness meditation on brain areas associated with pain modulation.

Insular Cortex Mediates Increased Pain Tolerance in Yoga Practitioners             
Together, these findings suggest that regular and long-term yoga practice improves pain tolerance in typical North Americans by teaching different ways to deal with sensory inputs and the potential emotional reactions attached to those inputs leading to a change in insular brain anatomy and connectivity.

Mindfulness Meditation-Based Pain Relief Employs Different Neural Mechanisms Than Placebo and Sham Mindfulness Meditation-Induced Analgesia
Recent findings have demonstrated that mindfulness meditation significantly reduces pain.” The practice of meditation activates specific brain areas known to be involved in pain modulation. In this study, mindfulness meditation provided a stronger analgesic effect than a placebo or sham meditation.

Yoga and other meditative movement therapies to reduce chronic pain
With an aging population and serious concerns regarding controlled substance abuse, the search for alternate therapies for treatment of chronic pain has gained momentum over the past 10 years. Based on this review, we conclude that it is safe to prescribe a gentle exercise program, such as yoga, as adjuvant therapy for those who suffer from chronic pain syndromes

Yoga for Military Veterans with Chronic Low Back Pain: A Randomized Clinical Trial
This study shows that yoga improves health outcomes, including lowered pain intensity and decreased use of opioids, for veterans with chronic lower-back pain.

Yoga for Persistent Pain: New Findings and Directions for an Ancient Practice 
Growing body of randomized clinical trials suggests that yoga may have promise for persistent pain conditions.

  1. Anxiety

Effect of Hatha Yoga on Anxiety: A Meta-Analysis
“Treatment efficacy was positively associated with the total number of hours practiced. People with elevated levels of anxiety benefitted the most.””

Effect of mindfulness and yoga on quality of life for elementary school students and teachers: results of a randomized controlled school-based study
Data suggested benefits by both students

Relaxation Response Induces Temporal Transcriptome Changes in Energy Metabolism, Insulin Secretion and Inflammatory Pathways
Relaxation Response, anxiety and aging

The Effect of Yoga on Stress, Anxiety, and Depression in Women
52 females in study indicated that yoga reduced depression, anxiety and stress.

Yoga Therapy and Polyvagal Theory: The Convergence of Traditional Wisdom and Contemporary Neuroscience for Self-Regulation and Resilience
This paper describes ancient yoga wisdom in terms of neuroscientific topics of self-regulation and resilience

Yoga for anxiety: A systematic review and meta‐analysis of randomized controlled trials  “Yoga might be an effective and safe intervention for individuals with elevated levels of anxiety.”

Yoga for Depression and Anxiety: A Review of Published Research and Implications for Healthcare Providers.  As an affordable and relatively accessible practice with research supporting cognitive and biological mechanisms, yoga is a promising modality for depression and anxiety management. According to this review, “The current evidence base is strongest for yoga as efficacious in reducing symptoms of unipolar depression.” It outlines potential risks that may be mitigated by working with a qualified yoga therapist.

 

  1. Respiratory Disorders/Breathing

4 Ways Yoga Fosters Respiratory System Health  In general, yoga exercises can reverse changes by: 1. Improving your posture by strengthening spinal muscles. 2. Increasing movement in your chest and spine by regularly stretching your chest muscles all directions. 3. Improving the flexibility and strength of your respiratory muscles and fascia by regularly practicing a combination of well-balanced asana sequences and breath practices.

Blood Pressure and Heart Rate Variability during Yoga-Based Alternate Nostril Breathing Practice and Breath Awareness  This study showed increased vagal function (and autonomic nervous activity), accounting for lowered blood pressure and increased heart rate variability during the yogic practice of alternate-nostril breathing.

Breathing Exercises and/or Retraining Techniques in the Treatment of Asthma: Comparative Effectiveness  “Yoga breathing may improve pulmonary function in adults in addition to reducing asthma symptoms”

Breathing exercises for chronic obstructive pulmonary disease  There was a significant improvement in six‐minute walk distance after three months of yoga involving pranayama timed breathing techniques

Effects of yoga training in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis   “Yoga training has a positive effect on improving lung function and exercise capacity and could be used as an adjunct pulmonary rehabilitation program in COPD patients.”

Yoga for Asthma   “There was some evidence that yoga may improve quality of life, improve symptoms, and reduce medication usage in people with asthma.”

Acute fall and long‐term rise in oxygen saturation in response to meditation   Meditation, a key component of yoga, seems to improve efficiency of gas exchange and oxygenation. This paper concluded that, “Meditation induces favorable changes in cardiovascular and respiratory end points of clinical interest.”

 

  1. Arthritis

Yoga Benefits for Arthritis  Even the Arthritis Foundation recommends Yoga.

Yoga for Low Back Pain    Blog by yoga therapist as an introduction to Cochran’s research links embedded.

Yoga in Rheumatic Diseases  This articles summarizes key considerations for yoga in rheumatic diseases, including clear guidelines to help healthcare practitioners find qualified yoga professionals. It concludes that a growing body of evidence suggests that yoga is a safe, feasible option for many living with rheumatic conditions. Furthermore, “This holistic approach to exercise with an emphasis on mindfulness and stress reduction may also offer additional opportunities to enhance psychological well-being, reduce pain and enhance function and participation, as part of a comprehensive disease management approach.”

YOGA IN SEDENTARY ADULTS WITH ARTHRITIS: EFFECTS OF A RANDOMIZED CONTROLLED PRAGMATIC TRIAL  In this 8-year clinical trial, conducted at Johns Hopkins University, a well-rounded yoga program for those with osteoarthritis and rheumatoid arthritis improved pain by 40%. Participants also demonstrated overall improvement in arthritis symptoms, physical fitness, psychological functioning, and health-related quality of life.

Effects of an Integrated Approach of Hatha Yoga Therapy on Functional Disability, Pain, and Flexibility in Osteoarthritis of the Knee Joint: A Randomized Controlled Study  An integrated approach of hatha yoga therapy is better than therapeutic exercises

Effects of Yoga on Symptoms, Physical Function, and Psychosocial Outcomes in Adults with Osteoarthritis: A Focused Review  Yoga intervention resulted in reductions in pain, stiffness, and swelling.

Impact of Iyengar yoga on quality of life in young women with rheumatoid arthritis”  Almost half of the yoga group reported clinically meaningful symptom improvement.”

The Ottawa panel clinical practice guidelines for the management of knee osteoarthritis. Part one: introduction, and mind-body exercise programs
Mind-body exercises are promising approaches to reduce pain, as well as to improve physical function and quality of life for individuals with knee osteoarthritis

 

  1. Trauma / PTSD

Effects of yoga on the autonomic nervous system, gamma-aminobutyric-acid, and allostasis in epilepsy, depression, and post-traumatic stress disorder SUCH AN IMPORTANT PIECE OF RESEARCH on STRESS. Yoga has far-reaching potential for the treatment of a broad array of disorders exacerbated by stress.

Meditation and Yoga for Posttraumatic Stress Disorder: A Meta-Analytic Review of Randomized Controlled Trials   This page features studies, articles, research databases, and other resources that support our work.

Mind body practices for PTSD  Mind-body practices were found to be a viable intervention to improve the constellation of PTSD symptoms such as intrusive memories, avoidance, and increased emotional arousal.”

New studies show that people suffering from posttraumatic stress disorder can find real relief with yoga.   It’s too soon to say whether yoga should replace traditional therapy as a treatment for PTSD, says trauma expert Bessel van der Kolk, a professor of psychiatry at Boston University School of Medicine. But he recommends it as a complementary practice. “Unless you befriend your body,” he says, “you cannot become well.”

Warriors at Ease Research on Yoga and Meditation   “Warriors at Ease is committed to raising awareness about how yoga and meditation can support the health and healing of service members, veterans, and their families….[read more about] evidenced-based, trauma-sensitive practices supported by research.”

Yoga as an adjunctive treatment for posttraumatic stress disorder: a randomized controlled trial.  Yoga significantly reduced PTSD symptomatology, with effect sizes comparable to well-researched psychotherapeutic and psychopharmacologic approaches. Yoga may improve the functioning of traumatized individuals by helping them to tolerate physical and sensory experiences associated with fear and helplessness and to increase emotional awareness and affect tolerance.”

Yoga, Trauma, and PTSD  Why Use Yoga for Trauma as an Adjunct Treatment for PTSD? Heather Mason will discuss this subject with us this week.

 

  1. Cardiovascular Disease

The hypotensive effect of Yoga’s breathing exercises: A systematic review   The pranayama with slower rhythms and manipulation of the nostrils, mainly with breaths by the left, present better results when compared with the other types and should be the main pranayama applied when the goal is to reduce blood pressure especially in hypertensive patients.

Effects of yoga in patients with paroxysmal atrial fibrillation – a randomized controlled study  Yoga with light movements and deep breathing may lead to improved QoL, lower blood pressure and lower heart rate in patients with PAF compared to a control group. Yoga could be a complementary treatment method to standard therapy.

Yoga as an Alternative and Complimentary Therapy for Cardiovascular Disease: A Systematic Review  This review demonstrates the clear potential yoga has as an alternative and complementary means to improve cardiovascular disease risk.

Blood Pressure Response to Meditation and Yoga: A Systematic Review and Meta-Analysis  While acknowledging the limitations of this research due to the differences in BP and the participants’ ages, meditation and yoga are demonstrated to be effective alternatives to pharmacotherapy. Given that BP decreased with the use of meditation and yoga, and this effect varied in different age groups, scientifically measured outcomes indicate that these practices are safe alternatives in some cases.

Effects of yoga on cardiovascular disease risk factors: A systematic review and meta-analysis This meta-analysis provides evidence for clinically important benefits of yoga on most biological cardiovascular disease risk factors, including blood pressure, respiratory rate, waist circumference, waist/hip ratio, cholesterol, triglycerides, and insulin resistance

Systematic Review of Yoga Interventions to Promote Cardiovascular Health in Older Adults.  According to this review of research on yoga and cardiovascular health, “Significant health benefits were reported, including favorable changes in blood pressure, body composition, glucose, and lipids.”

Can lifestyle changes reverse coronary heart disease?  Dean Ornish’s team has many years of research to support the efficacy of a multifaceted lifestyle program—including yoga, meditation, nutrition, and social support—in improving cardiovascular outcomes and even reversing heart disease.

 

  1. Sleep (inclusive of Insomnia)

The Connection Between Yoga and Better Sleep  Some types of yoga can be energizing (like hot yoga and vigorous vinyasa flow), which won’t help you relax as well as restorative styles of yoga like hatha and yoga nidra. A yoga therapist can help you choose the right tools.

The Effect of Yoga Therapy on Selected Psychological Variables Among Male Patients with Insomnia  We conclude that yoga is an effective treatment option for the patients with insomnia. There are no major side effects.

Yoga Can Help With Insomnia  Looking for a low-impact exercise routine with high returns for health and sleep? Try yoga.

Yoga decreases insomnia in postmenopausal women: a randomized clinical trial  This research used a specific routine. Yoga Therapists read and implement research unlike yoga instructors.

Yoga for Better Sleep  Over 55% of people who did yoga found that it helped them get better sleep.

Sleep quality, depression state, and health status of older adults after silver yoga exercises: Cluster randomized trial  “After 6 months of silver yoga exercises, the sleep quality, depression, and health status of older adults were all improved.”

Subjective Sleep Quality and hormonal modulation in long-term yoga practitioners  It can be concluded that long-term yoga practice is associated with significant psycho-biological differences, including better sleep quality as well as a modulatory action on the levels of cortisol.