Monthly Archives: June 2017

Yoga for Heart Failure

I feel beautiful.  Participant feedback after an 8-week Yoga course for CHF

Almost six million people in the U.S. have congestive heart failure, and its the most common reason for those over the age of 65 to be hospitalized. Often a pattern develops of frequent hospitalizations, a revolving door in and out.

Many factors contribute to worsening function that requires a trip back to the wards. Stress, depression, and a lack of social support are associated with a worse prognosis independent of other medical or physical risk factors. The American Heart Association notes that stress reduction is one of the most important recommendations for people suffering from congestive heart failure.

Lifestyle changes like exercising, managing stress, losing excess weight, and decreasing the amount of dietary salt can drastically improve the ability to function and the quality of life of people with heart failure.

Yoga has been shown in repeated studies to decrease stress and to alleviate depression. It incorporates physical exercise as asanas and employs stress reduction techniques with breath work and meditation, all potentially helpful practices for those with congestive heart failure.

To determine the feasibility of a Yoga practice for typical heart failure patients, an 8-week pilot study was recently undertaken in northern California. The primary objective was to determine if a community-based, racially diverse Yoga program would be feasible in a low-income area where Yoga and other mind-body modalities are not readily available. The secondary objective of the study was to determine the effects of a Yoga practice on weight loss, depression, and quality of life.

Fourteen men and women took a Hatha Yoga course twice a week that lasted for eight weeks. The program was developed by a local nonprofit group in Oakland, the Niroga Institute, which promotes Yoga for individuals with specific needs. It included, among others things, versions of:

  • Trikonasana (standing side bend)
  • Setu Bandha Sarvangasana (bridge)
  • Supta Padangusthasana (reclining big toe)
  • Paschimottonasana (seated forward bend)
  • Nabhiasana (prone boat)
  • Marjariasana (cat)
  • Ardha Matsyendrasana (seated twist)
  • Viparita Karani (doing inversion, or legs-up-the-wall)
  • Savasana (corpse)
  • Pranayama, exhalation twice as long as inhalation
  • Meditation for 5 minutes in any comfortable position
  • Mindfulness practice for impulse control, enhanced self-awareness, development of fearlessness, desirelessness, detachment, and dispassion

 

In addition to the group classes, many of the participants practiced individually at home with or without a DVD provided by the Niroga Institute.

Thirteen of the 14 subjects completed the 8-week course with most of them attending at least 75% of the classes. One person joined the group for less than half the time. Given the severity of illness of the group, those are pretty good study retention numbers.

At the end, these 13 people with congestive heart failure felt better overall with their quality of life (as measured by a standardized test) improved. The effect did not reach statistical significance (p = .08), possibly because of such a small sample size. Their depression lessened (as measured by a standardized test) with the number of participants reporting moderate to severe levels decreasing from eight to four, a significant result. There was also a trend in weight reduction. The average loss was 3.5 pounds over eight weeks.

Unfortunately, this research employed no control group and relied upon self reporting for many of the indices. Its a small positive step though, in validating Yogas therapeutic potential, and it corroborates another similarly designed trial of 15 patients with CHF in which quality of life was significantly improved and an improvement of balance, endurance and strength was noted.

I believe that there is little room for doubt about the benefits of a multi-faceted Yoga lifestyle for people with heart failure. Keep in mind as well that the best way to prevent heart failure is to control risk factors and conditions that cause it coronary artery disease, high blood pressure, high cholesterol, diabetes and obesity. Yogas holistic attention to nutrition, exercise, stress reduction, and mindfulness help us to do just that.

References:

  1. Ai Kubo, Yun-Yi Hung, and Jeffrey Ritterman. Yoga for Heart Failure Patients: A Feasibility Pilot Study with a Multiethnic Population. International Journal of Yoga Therapy. 2011; 21:77-83.
  2. Howie-Esquivel J, Lee J, Collier G, Mehling W, Fleischmann K. Yoga in heart failure patients: a pilot study. Journal of Cardiac Failure. 2010;16:742-9.

Yoga for Arthritis

A recent message:

Is it wise to work an arthritic hip with yoga? I have the beginnings of arthritis in my hip.

This is a common concern that maybe we should rest arthritic joints to avoid more wear and tear. From a mechanics perspective, it makes sense. Using a mechanical part too much decreases its life span.

But joints arent inanimate. Theyre part of us, of our living structure. Just like bones and muscles, joints are dynamic structures that need use and attention to keep working optimally. One of the best things we can do is to exercise a troubled joint. Taking it through a full range of motion increases lubrication with synovial fluid. The fluid is full of nourishment, and it feeds the joint for healing. As it washes through, it also cleanses and removes toxic waste products of metabolism and inflammatory mediators.

Exercising the joint through a full range of motion is important, but just as essential is that it doesnt bear more load than it was designed to handle. Even just five to ten pounds of extra weight puts a significant burden on a joint, and shedding those few pounds is absolutely the best thing that can be done to prevent further degradation.

Improving the strength of surrounding muscles with weight training helps. So does increasing the amount of omega-3 fatty acids in the diet, preferably through vegetarian sources like flax seed, chia seeds, and walnuts. Low vitamin K levels have been linked with the progression of osteoarthritis. Eat lots of leafy greens, too.

Persistent organic pollutant, or POPSs, are those nasty synthetic chemicals that have become stuck in our environment, unable to be degraded well either by the elements or by animals. They bio-accumulate through the food chain. Ninety percent of what gets into our bodies comes from meat and dairy, and once ingested they tend to stay in our bodies for decades. Although POPs are generally considered harmless in the concentrations found in humans, there is increasing concern in the scientific community that they may be contributing to our obesity epidemic. There is some possible correlation with arthritis as well. Thats another good reason to follow traditional Yoga advice and avoid animal flesh in the diet. If you like dairy, consider limiting the quantity and choosing organic products in small amounts.

References:

  1. Roush JK, Dodd CE, Fritsch DA, Allen TA, Jewell DE, Schoenherr WD, Richardson DC,Leventhal PS, Hahn KA. Multicenter veterinary practice assessment of the effects of omega-3 fatty acids on osteoarthritis in dogs. J Am Vet Med Assoc. 2010 Jan 1;236(1):59-66.
  2. Oka H, Akune T, Muraki S, En-yo Y, Yoshida M, Saika A, Sasaki S, Nakamura K, Kawaguchi H, Yoshimura N. Association of low dietary vitamin K intake with radiographic knee osteoarthritis in the Japanese elderly population: dietary survey in a population-based cohort of the ROAD study. J Orthop Sci. 2009 Nov;14(6):687-92. Epub 2009 Dec 8.
  3. Lee DH, Steffes M, Jacobs DR. Positive associations of serum concentration of polychlorinated biphenyls or organochlorine pesticides with self-reported arthritis, especially rheumatoid type, in women. Environ Health Perspect. 2007 Jun;115(6):883-8. Epub 2007 Feb 20.
  4. Bennell KL, Hinman RS. A review of the clinical evidence for exercise in osteoarthritis of the hip and knee. J Sci Med Sport. 2011 Jan;14(1):4-9. Epub 2010 Sep 17. Review.
  5. Chyu MC, von Bergen V, Brismée JM, Zhang Y, Yeh JK, Shen CL. Complementary and alternative exercises for management of osteoarthritis. Arthritis. 2011;2011:364319. Epub 2011 Jul 25.
  6. Anandacoomarasamy A, Fransen M, March L. Obesity and the musculoskeletal system. Curr Opin Rheumatol. 2009 Jan;21(1):71-7. Review.