Active Engagement: Yoga and Osteoporosis

by Baxter

Roots and Water by Brad Gibson

Earlier this summer, some good news was reported in the New York Times about recent study on the benefits of yoga asana for osteoporosis. Physiatrist Loren Fishman, MD (a physiatrist is an MD who works mostly with helping to rehabilitate those with chronic illnesses and injuries without the use of surgery) released the results of a study on the potential benefits of yoga on the progression, or course, of osteoporosis. Originally enlisting over 180 subjects, the study had participants attend a series of classes to learn a short 10-minute home yoga practice that they were then asked to do daily for two years. Knowing human nature, it is perhaps not surprising that only 11 participants were able to complete the study as required. But those who did had some very encouraging results: an increase in the bone density of hips and spine, while the seven controls with osteoporosis continued to lose bone mass. That’s right, the bones of the yoga practitioners actually got stronger. The downside to this result, of course, is the small number of folks who stuck to it, which means that additional larger studies will be required to confirm these initial encouraging results.

Sadly, we live in a culture that often is looking for the quick fix, the one-pill solution, or the single visit to the doc for the cure. The yoga tradition is pretty clear on how positive change occurs, and how goals are met through regular practice done over the long haul. And this ongoing active engagement concept seems supported by the results from this study. Got 10 minutes a day?

For more about this study and what it might mean for you, check out the New York Times article here. You can get complete information on the study (and see the poses included in the osteoporosis yoga practice) here.

Next week, my Rx for osteoporosis in your home practice. If you can’t wait till then, know that all of your yoga poses are “weight bearing,” so keep on doing some poses you love for now, and I will add in my favorite picks next time!

And remember to ask us questions for our Friday Q&A. Leave questions in a comment or email us at the address in the Contact Us page. 

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Friday Q&A: Relationship between Diet and Asana Choices, Sore Shoulders and Neck, and Practicing Yoga at Home

Q: I have been practicing yoga regularly for 20 some years and am approaching my 55th birthday. While I know my asana practice has been immensely helpful with my aging process I have still had trouble with a few issues: blood pressure, glaucoma, heart rate, fatigue. Lately I have been working with my diet and specifically cutting back and nearly eliminating alcohol (I do miss the occasional glass of wine), dairy, and a few other foods that seem to aggravate joint pain, heart palpitations, and lethargy. Some but not all of these choices line up with my doshic make-up (pitta/vata). Most of the choices come from Alejandro Junger's book Clean. I am curious about diet and asana choices for particular conditions related to age.

A: As a scientist who also studies aging, I am especially intrigued about how diet can influence lifespan and health. However, that is not something I want to discuss here, as I am not a nutritionist or trained in this area. It is also something that is hugely complicated, and some of the better scientific controlled studies are not done in humans, but rather in mice or other animal models. For example, I recently attended a symposium in Cape Cod in March on Metabolism and Aging sponsored by Cell Symposia and Elsevier (see here). Data is clearly emerging about how diets high in fat and/or cholesterol are contributing to metabolic dysregulation. But defining the precise molecular pathways that regulate and control our basic metabolism and how diet can contribute to age-related diseases, such as type 2 diabetes, cardiovascular disease, and hypertension, is still in its infancy. At this point I would recommend only common sense. You know, the stuff your grandma was supposed to teach you: eat in moderation and eat your vegetables. —Brad

A: To be honest, I’ve been dreading this question, but, sigh, I knew it was coming. Unfortunately, although it is commonly acknowledged that a “healthy” diet is an important aspect of healthy aging, there is so much controversy about what that healthy diet entails (dairy, for example, is recommended in some diets and not in others) that we have decided not to address this issue on our blog because a) we don’t have the expertise and b) diet doesn’t fall under our topic of “yoga for healthy aging.” In addition, none of us are experts in Ayurvedic medicine and we do not follow its dietary recommendations, so we are going to refrain from commenting on that as well. (Personally I think that is important to listen to your body; if some type of food has a negative effect on you and eliminating it doesn’t compromise your ability to get complete nutrition, then go for it.)

For your high blood pressure, heart rate, and fatigue, you may find the practices Baxter and I mentioned this week (mindful meditation, yoga nidra, and breath awareness) useful. And we’ll be sure to recommend more poses for each of those conditions as time goes on. —Nina

Q: Any suggestions for very sore shoulders/neck besides downward facing dog, twists and standing yoga mudra? 

There are two different approaches to relieving pain in your neck and shoulders. You can stretch them (as you have been doing) or you can relax them. A pose for stretching that shoulders and neck that can be particularly helpful if you’ve been sitting at a desk all day is a passive backbend over a rolled-up blanket or yoga mat.

Passive Backbend (from "Moving Toward Balance," Rodney Yee with Nina Zolotow)

If your head doesn't reach the floor in this pose, place a folded blanket or towel underneath it for support.

Baxter recommends dynamic movement to release the shoulders and neck, such as moving from Mountain Pose (Tadasana) with your arms at your sides to arms overhead (Urdva Hastanasa) with a slight backbend, following your breath.

A good pose for relaxing your shoulders and neck is Standing Forward Bend at the wall (sometimes called Wall Hang). This allows you to release your shoulders and neck with gravity. Here are two versions:

Wall Standing Forward Bend Version 1 (from "Moving Toward Balance")

Wall Standing Forward Bend Version 2 (from "Moving Toward Balance")

—Nina

Q: One of the major challenges for me is allowing myself time to do yoga practice at home. I feel so much better when I do, even a brief morning session, but I seem to find it very hard to give myself that space in my overly busy life. I realize this arises largely out of my own issues, but do you have any comments/suggestions besides trying to make it part of my usual routine, like brushing my teeth.

Congratulations on starting a home practice! Practicing at home is one of the best ways to do yoga for healthy aging because you can do what you need (rather than just hoping your teacher will be on the same wavelength that you are that day). Here are a few suggestions for motivating yourself to practice at home:

1. Start with a very short routine, maybe even just a single pose, so it’s not too overwhelming to contemplate. Your practice will build over time. 
2. You don’t have to practice in the morning if that doesn’t work well for you. Some people like to get it over with first thing, but others like to wait until they’re really in the mood, like in the afternoon or early evening. 
3. Find a practice partner. (I used to think that no one would ever want to come over to my house and practice with me, but I turned out to be very, very wrong.) 
4. Listen to music while you practice, wear your favorite perfume, pet your dog between poses, or do anything else that makes it a little more fun.

—Nina

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Accepting Reclined Leg Stretch

by Nina

An excellent time to combine acceptance with active engagement (as Baxter discussed in his post yesterday) is when you are doing yoga poses. By far, the healthiest and most effective way to do yoga poses is to cultivate an awareness of your body’s current state while at the same time actively working toward making changes to it, such as stretching or strengthening. This is one of the best ways to protect yourself from injury. And it also helps you reap the most benefits from your poses.

When I was trying to think of a pose that epitomized this need for both acceptance and active engagement, Reclined Leg Stretch pose (Supta Padangusthasana) sprang to mind. To be honest, that’s because every time I've taught the pose, I’ve seen people “cheat” (yes, I’m talking about you with the bent leg over there), a sure sign that the “acceptance” side of the equation is lacking.

Reclined Leg Stretch (Supta Padangusthasana) is a very beneficial pose because it revitalizes your legs while it eases tension in your lower back. It stretches your hamstring muscles and your hip joints, which is important for maintaining physical health if you sit at a desk or walk a lot. It is also helpful for lower back pain and maintaining a healthy back. And it’s a great way to begin a yoga practice or even to do as a “single pose practice.” Plus, you get to do it lying down! 

Baxter prescribes it for: 

• leg fatigue or weakness 
• lower back conditions 
• arthritis 
• knee pain 
• swelling of feet and ankles 
• maintaining flexibility of the legs and hip joints as you age

However, most people are too tight in their hamstrings to do the pose like their teachers or the pictures they’ve seen, so some (not naming any names here) cheat by bending the knee of their top leg or by lifting their pelvis off the floor in order to bring their toe closer to their head.

Can you do it like this? (From "Moving Toward Balance," Rodney Yee with Nina Zolotow)

But while cheating may make you feel more flexible, bending your top knee means that you won’t be getting the full hamstring stretch that’s so beneficial. So the next time you do this pose (and it’s a great one to practice at home), use a strap or belt around the arch your foot and hold the right side of the strap in your right hand, the left in your left hand. Now be honest with yourself. Is your upper leg truly straight? And is your pelvis resting evenly on the ground? If not, let your leg go until your knee is straight, your pelvis is even, and your leg reaches its natural angle (90 degrees or less, even much less).

Using a strap. (From "Moving Toward Balance," Rodney Yee with Nina Zolotow)

That’s the acceptance part. The active engagement part is to stay in the pose for 45 to 90 seconds and to practice regularly. Although we can’t promise it, there’s a very good chance that over time this pose will increase your flexibility, making many other poses more comfortable and enhancing your physical health.

Some helpful variations:

• If your head and shoulders aren’t resting comfortably on the floor, use a folded blanket under your head. 
• If you are so tight that it’s hard to hold your leg with a strap, do the pose with the bottom leg extending through a doorway and your top foot resting on the wall next to the doorway. 
• If you want to strengthen your bottom leg as your stretch the top one, you can practice with your bottom foot pressing against a wall.

Cautions: If you have lower back issues, you may need to keep your bottom leg bent. If you have wrist issues, you may need to change the way you hold the strap.

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What We Need to Practice

by Baxter

Cathedral in Progress by Brad Gibson

As I was enjoying Brad’s post from last week (he really cracks me up—smart and funny!), one statement jumped off the computer screen as I read it. Regarding confronting the inevitable course of aging, Brad stated, “We probably need to practice both acceptance and active engagement as we confront our own aging....”

Men Working on La Sagrada Familia by Brad Gibson 

As I thought about the acceptance part of that equation, it reminded me of an experience a friend of mine had while living for a while at an ashram in Northern California. In addition to the center’s own spiritual leader, there were often visiting teachers and gurus, and one visiting guru had a seemingly straightforward message that went something like this: “Everything is already okay!” Well, this message really seemed to resonate with the staff at the center, especially with the kitchen staff, who took it to heart, so much so that the dirty dishes started to pile up. After all, everything is already okay! Finally, the ashram’s main teacher had to remind everyone that, even though this idea was certainly true, especially as a concept found in many yoga lineages, we also have work to do in this lifetime.

Yoga posits an intriguing paradox that we each have a perfect, eternal quality already within us, sometimes referred to as the purusha or atman, and at the same time, we have a personal dharma or path to follow that requires active engagement in this lifetime. As a way of supporting the notion of healthy aging, I am able to “actively engage” in my life’s work as well as beneficial practices, such as yoga asana (poses) and pranayama (yogic breathing), that support the overall health and well being of my mind and body. And at the same time, I can access other yoga practices, such as mindful meditation and yoga nidra, where I am more involved in accessing the state of “being” as opposed to the state of “doing.” In these practices, I am able to tap into the acceptance part of the challenge of aging, and also this alluring concept that everything is already okay. We have come to discover through observation and research that this second set of practices (the acceptance practices), has very tangible benefits as well, including, to name a few, quieting the nervous system, lowering blood pressure, and supporting healthy digestion and immune function. For those of you not familiar with these practices, I would recommend the following books as an introduction:

• Full Catastrophe Living by Jon Kabat-Zinn, Ph.D., for information about mindful meditation 
• Yoga Nidra by Richard Miller, Ph.D., for information about yoga nidra (an audio CD with practice for you is included) 

More on active engagement next time!

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Stress Test

by Nina

Under the Beach Umbrella by Joan Webster 

“You did great,” my oral surgeon said. “In fact, you were the most relaxed patient I’ve ever worked on. You even fell asleep there for a while.”

“Wasn’t asleep,” I mumbled through my numb and swollen lips. “Was doing yogic breathing.”

He looked at me with fascination, then quickly handed me a piece of paper and a pen. “Could you write down what you did for me?”

“Uh, email you later?”

Of course I didn’t become so good at yogic breathing just so I could stay, uh, relatively relaxed during gum surgery (though it was certainly an interesting test of my skills). As someone who once suffered from agitated depression, I’ve been using yogic breathing, along with many yoga techniques, for many years to manage my stress levels for my emotional wellbeing.

Now it turns out that I’ve been practicing yoga for healthy aging while I was at it. Because I can tell you right now that along with exercise and diet, stress management is one of the most important keys to healthy aging. Chronic stress contributes to many common age-related diseases, such as high blood pressure and heart disease, and can cause a weakened immune system overall. It also affects the quality of your life. Possible effects of chronic stress include: chronic anxiety or depression, insomnia and/or fatigue, headaches, and digestive disorders.

And how does yoga help you manage your stress? Let me count the ways:

• breath practices and meditation trigger the relaxation response 
• inverted poses (and semi-inverted poses) physically reduce your stress levels 
• restorative yoga poses relax your body and quiet your nervous system
• active yoga poses (such as standing poses, twists, and backbends) release stress from your body and create a focus for your mind
• yoga philosophy teaches you to cultivate equanimity in the face of difficulty

Over time, I’ll be providing detailed information and instructions for techniques in each of these different categories. And I hope very much that you’ll find one or more that’s useful.

And in case you’re wondering, yes, I did eventually email my oral surgeon. Next time you’re in a dentist chair (or are lying sleepless in bed, need a break after a stressful day, or just want to experiment), maybe you can try:

Breath awareness. Focus your attention on your natural breath, observing how your abdomen or chest rises with your inhalation and falls with your exhalation. When your mind wanders from your breath (to the dental procedure or any other topic), simply, and without judgment, return your attention to your breath. It is natural to be distracted from this practice, but it seems to work even if your attention wanders repeatedly.

Focusing on your breath will enable you to keep your mind of neutral topics rather than stressful ones, and after 10 or 20 minutes, the relaxation response (identified by Dr. Herbert Bensen of Harvard Medical School in the 1970s) will be triggered. 

Extending the Exhalation. The heart slows during the exhalation (and speeds up during the inhalation) so extending your exhalation is a relaxing breath practice (and also provides the benefits of breath awareness above). Take a deep soft inhalation followed by a deep soft exhalation. At the end of the exhalation, instead of inhaling again, retain your exhalation for one or two beats. Repeat through the procedure. Keep it easy. At no time should there be strain. If needed, return to your natural breath at any time. 

During my procedure I did the second breath practice (extending the exhalation). But I’m very experienced with yogic breathing, and we generally recommend that beginners to start with simple breath awareness. 

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Clarification: Aging, Yoga and Science

by Brad

Winter Trees by Brad Gibson

Today’s post is largely in response to the question: How would one go about investigating the effects of yoga on aging scientifically? Before tackling this question—which I will get to in the next week or two—I will first attempt to define or at least discuss a few key terms and assumptions. The reasons for this will hopefully become clear.

In the broadest the terms, “aging” applies to how systems or entities change with time. To inanimate objects, such as your new car or jacket, this begins right after it’s manufactured or, more relevantly, after you bought it. This process of aging can be rapid or slow (weeks, months, or years), and depends a lot on what the object is and what it was designed for. In biological systems (including us), we typically think of aging as starting after development, or post-puberty in our case. We also tend to associate aging with a decline and/or loss of functions, both physical and mental. However, aging can include more positive properties or phenotypes, such as increased knowledge and skill sets, and it isn’t all that hard to name a few that fit into this category. But in most biological scientific studies of aging, we refer to aging mostly in the former sense, i.e., an accumulation of mostly pathological properties, such memory loss, frailty, neurodegenerative diseases, bone loss, muscle loss, and so on. Surprisingly there are quite a few competing theories of basic aging, such as error accumulation, telomere shortening, antagonistic pleiotrophy, free-radical theory, and entropy, just to name a few. What all (or most) of these theories seek to address is the underlying molecular and physiological event that drives these largely negative processes. 

The term “successful aging” is more recent, having come into wide use in the last few decades. If you want to read more about this concept, I found the first chapter in the book Successful Aging: Perspectives from the Behavioral Sciences by Paul and Margaret Baltes quite useful (for information see Cambridge ebooks). 

Even last week as I read the science section of the New York Times (see NY Times), I came across a short review of a just-published study on “Alcohol Consumption at Midlife and Successful Ageing in Women: A Prospective Cohort Analysis in the Nurses Health Study” (see PLOS). In this prospective correlative study, researchers at Harvard demonstrated that a modest increase in successful aging for women who consumed small, but regular amount of alcohol at mid-life. (Maybe a glass of wine after yoga class isn’t such a bad idea after all?). Here they defined "successful aging" in a more precise manner: "as being free of 11 major chronic diseases and having no major cognitive impairment, physical impairment, or mental health limitations." Of course, this more operational definition to successful aging made it easier to make clear and objective distinctions among the woman in this group, typical of population based epidemiological studies. 

When we chose the term ‘healthy aging’ for this blog, the purpose was to provide information not on just how practicing yoga might help to avoid or reduce your chances of acquiring one or more of these age-related losses, but also to better manage and minimize their impact when they occur. Indeed, this is the position most of us are in, whether is through the vagaries of our genetic background, chance, past behavior, or whatever. (This reminds me of the joke: Q: What’s the best thing you can do to insure a long life? A: Choose your parents well.) So as I go back and reconsider the original question on how science can study the relationship of yoga and aging, I will reframe this question a bit: How can science study the effects of yoga on our overall physical and mental health as we age? I’ll tackle this question next time…. But as a preview, there are few good places to start, including the 2009 pilot study in Lancet on comprehensive lifestyle changes and telomere length (a biomarker of aging and cellular senescence) and several recently funded NIH studies examining yoga’s effects on depression, fatigue, and menopause. 

And please leave any questions for the Friday Q&A in the comments.

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Mr ATM 2011–Full results

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