1. ©2015 MFMER | slide-1 Yoga as Medicine Natalie E. Gentile, MD PGY-2 Mayo Clinic Family Medicine Residency RYT-100 Certified Power Vinyasa Yoga Teacher 89 th Annual Clinical Reviews October 27 and November 10, 2015

2. ©2015 MFMER | slide-2 Disclosures None

3. ©2015 MFMER | slide-3 Objectives The provider will be able to Counsel patients about the benefits of yoga Dispel common myths about yoga Identify common primary care diagnoses that would benefit from prescribing yoga

4. ©2015 MFMER | slide-4 2012 National Health Interview Survey Nearly 18 million adults and 927,000 children practiced meditation Among Americans age 18–44, yoga use nearly doubled since 2002 Americans age 45–64, practicing yoga increased 5.2% in 2002  7.2 % in 2012 400,000 more children aged 4-17 used yoga in 2012 than in 2007 https://nccih.nih.gov/news/press/02102015mb

5. ©2015 MFMER | slide-5 Common Diagnoses in Primary Care Diabetes Hypertension Abdominal pain Chronic pain (osteoarthritis, fibromyalgia, joint pain, low back pain) Anxiety/depression Obesity Respiratory problems (COPD, asthma) Falls

6. ©2015 MFMER | slide-6 The Vicious Cycle Disease Poor Health Habits Stress Stressful Life Event Negative Coping Mechanisms Unintended weight gain, elevated BP, pre-diabetes

7. ©2015 MFMER | slide-7 Stress and Disease Human Body Metabolic Obesity Musculoskeletal Pain Neurological Migraine Gastrointestinal Irritable Bowel Syndrome Cardiovascular Heart disease, hypertension Psychiatric Addiction, Depression, Anxiety Stress

8. ©2015 MFMER | slide-8 Prescribing Yoga

9. ©2015 MFMER | slide-9 Hayes, M. and S. Chase, Prescribing yoga. Primary care, 2010. 37(1): p. 31-47.

10. ©2015 MFMER | slide-10 Yoga as Medicine: Psychiatry/Psychology Emotional regulation Yoga (as an adjunct to physical education) is helpful in adolescents Depression-Evidence rating B Yoga is superior to placebo for depression with no adverse events reported, although there are no clear necessary or sufficient styles, postures, or practice durations. Anxiety RCTs show consistent positive effects of yoga on anxiety disorders compared with placebo Exercise, Yoga, and Meditation for Depressive and Anxiety Disorders. 2010 Accessed on 10/2/15; Available from: http://www.aafp.org/afp/2010/0415/p981.html. http://www.aafp.org/afp/2010/0415/p981.html Daly, L.A., et al., Yoga and Emotion Regulation in High School Students: A Randomized Controlled Trial. Evidence-based complementary and alternative medicine : eCAM, 2015. 2015: p. 794928.

11. ©2015 MFMER | slide-11 Yoga as Medicine: Gastrointestinal Irritable bowel syndrome Yoga showed significant decreases in IBS severity measures, visceral sensitivity, and severity of somatic symptoms Shahabi, L., B.D. Naliboff, and D. Shapiro, Self-regulation evaluation of therapeutic yoga and walking for patients with irritable bowel syndrome: a pilot study. Psychology, health & medicine, 2015: p. 1-13.

12. ©2015 MFMER | slide-12 Yoga as Medicine: Cardiovascular Yoga program vs. brisk-walking program In elderly individuals with increased pulse pressure, yoga was more effective in reducing arterial stiffness along with blood pressure Yoga can significantly reduce sympathetic activity, bioavailability of nitric oxide  improved endothelial function Patil, S.G., M.R. Aithala, and K.K. Das, Effect of yoga on arterial stiffness in elderly subjects with increased pulse pressure: A randomized controlled study. Complementary therapies in medicine, 2015. 23(4): p. 562-9.

13. ©2015 MFMER | slide-13 Yoga as Medicine: Pain Arthritis Yoga associated with lower pain and stiffness, greater walk distance, chair stands, seated reach and gait Chronic low back pain Study designed and validated an integrated yoga therapy module which had no adverse effects and was useful in alleviating pain, disability, and perceived stress in chronic low back pain Sharpe, P.A., et al., Association of complementary and alternative medicine use with symptoms and physical functional performance among adults with arthritis. Disability and health journal, 2015. Patil, N.J., et al., Designing, validation, and feasibility of integrated yoga therapy module for chronic low back pain. International journal of yoga, 2015. 8(2): p. 103-8.

14. ©2015 MFMER | slide-14 Yoga and Other Forms of Exercise One of the few forms of exercise that EVERYONE can do and from which EVERYONE can benefit An adjunct to strength training, running, etc. Yoga can be the primary form of physical activity (i.e. personal preference, disability, injury, access) Increasing blood flow, oxygen, muscle strength, flexibility, and BALANCE! Increasing the parasympathetic response  stress reduction

15. ©2015 MFMER | slide-15 Yoga as Medicine: Tailoring to the Needs of the Patient Safety Problem specific Access to yoga ($$, location, time) Resources YouTube Local fitness centers Free community classes Google Yoga Studios Magazines

16. ©2015 MFMER | slide-16 The Myths “I’m not flexible” “I’m not built like the people who do yoga” “Yoga is only for women” “It is a religious practice that goes against my beliefs” “I’ve never done it before” “I’m not good at it” Dispelling the myths

17. ©2015 MFMER | slide-17 Eight Limbs of Yoga a la Patanjali Yoga=union of Yama: Code of conduct for ethical lifestyle Niyama: Self-discipline Asana: Physical Postures Pranayama: Breath Control Pratyahara: Withdrawal of senses from external objects to increase self- awareness Dharana: Concentration Dhyana: Meditation, contemplation Samadhi: Oneness with the object of meditation, enlightenment http://www.yogajournal.com/article/beginners/the-eight-limbs / Mind Body Spirit

18. ©2015 MFMER | slide-18 Lead by Example: Practical Portion Guided meditation/Pranayama Sun Salutations

19. ©2015 MFMER | slide-19 Questions & Discussion