Medical Journal Publishes PYI-Led Pilot Study on Yoga for Cardiac Health
Really good tidings! Motivated by her mother’s own cardiac event, Prema Yoga Institute alumna and faculty member Sonja Rzepski created a yoga therapy program alongside doctors at New York’s Lenox Hill Hospital to help manage stress in female patients recovering from similar experiences. The cardiac care program was part of PYI's Clinical Yoga Therapy Practicum, and was staffed by PYI grads completing their yoga therapy certification.
Really good tidings! Motivated by her mother’s own cardiac event, Prema Yoga Institute alumna and faculty member Sonja Rzepski created a yoga therapy program alongside doctors at New York’s Lenox Hill Hospital to help manage stress in female patients recovering from similar experiences. The cardiac care program was part of PYI's Clinical Yoga Therapy Practicum, and was staffed by PYI grads completing their yoga therapy certification.
The results are in and not only are they are encouraging but they are now published in the Annals of Clinical Cardiology (Jesus SD, Schultz E, Bond RM. The yoga–meditation heart connection: A pilot study looking to improve women's heart health. Ann Clin Cardiol 2019;1:24-9).
While on the decline overall, the CDC still declares heart disease the leading cause of death for women in the United States. For women older than 55, the data shows a stagnation in the decrease of fatal incidents. Stress, anxiety, and depression are nontraditional risk factors for cardiovascular disease (CVD) that are more common in women. Sonja’s hypothesis appears to be supported by evidence that regular, supervised sessions of chair yoga and meditation can be a complementary measure to decrease these factors in female patients with or at risk for CVD, as well as increase their likelihood to pursue lifestyle modifications.
Sonja’s program addressed this specific group by providing 16 female participants with or at risk for CVD and with a mean age of 64, 45-minute supervised sessions of complimentary chair yoga and meditation over 24 weeks. Through the practice of Yoga Nidra, psychic sleep or deep relaxation with inner awareness, the patients reported a lower level of depression overall as well as a 3-9 pound weight loss in 1/3 of the students which reflects the program’s encouragement to mindfully eat heart-healthy foods.
Kudos to Sonja and her team that included PYI Practicum students Yuliana Kim Grant, Irina Chernova, Judy Glassman, and Michelle Lauren. Want to dig in and read the complete study? Click here!
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Yoga Tips For Holiday Digestion
As a vegetarian married to a vegan, I’ve grown accustomed to dealing with a great deal of well-meaning fretting from both my mother and my mother-in-law when my husband and I visit our families for the holidays. My mother brought me up on the USDA’s “Four Food Groups” nutritional model of the 1970s; in her mind, a proper dinner consists of a meat-based main dish accompanied by a vegetable, a plant-based starch, and white rolls with margarine. There are no exceptions to this rule, and she prides herself on having provided me, my three sisters and our father with a “proper” dinner every single night for 20 years. And don’t get me wrong, I appreciate it.
As a vegetarian married to a vegan, I’ve grown accustomed to dealing with a great deal of well-meaning fretting from both my mother and my mother-in-law when my husband and I visit our families for the holidays. My mother brought me up on the USDA’s “Four Food Groups” nutritional model of the 1970s; in her mind, a proper dinner consists of a meat-based main dish accompanied by a vegetable, a plant-based starch, and white rolls with margarine. There are no exceptions to this rule, and she prides herself on having provided me, my three sisters and our father with a “proper” dinner every single night for 20 years. And don’t get me wrong, I appreciate it. The idea of coming home from a long day of work and cooking a full dinner for six people even once a week makes me want to get into child’s pose and stay there. My husband’s mother was a pediatric nurse who often worked the evening shift, so his father—not a man who grew up cooking— was usually responsible for providing nightly dinner for three growing boys, on a budget. Unsurprisingly, to this day it is hard for my husband’s parents to conceive of a family dinner that doesn’t revolve around two to three pounds of hamburger incorporated into a recipe off the back of a box.
Like many loving mothers of adult children, my mother and my mother-in-law remain consumed with concern about what and when and how often my husband and I eat, especially when we’re in their homes. Cooking and serving food is a way of showing love, and it is frustrating to both of them to be denied the pleasure of making our favorite childhood foods now that we no longer eat many of them. Even more so, I think their concern stems from a phenomenon common to non-vegetarians, namely, a sincere worry that vegetarians and vegans simply aren’t getting sufficient nutrients. It’s been well over a decade since we both stopped eating meat, but at family functions the question still arises with seemingly unassuageable vexation: “Will there be anything for you to eat?!” Unsurprisingly, the issue assumes an even greater intensity around the holidays, particularly Thanksgiving (which, in my husband’s family, is celebrated as less of a holiday and more of a 14-hour competitive eating decathlon).
Two years ago, after remaining at home in New York City for Thanksgiving for logistical reasons and fielding agitated FaceTime calls from both of our mothers –-“Did you get enough to eat?!” (his) “What did you even eat?!” (mine), we decided to put our parents’ minds at rest once and for all. After a bit of persuading, we convinced our families to let us cook them vegetarian/vegan holiday meals last year—we visited his family for Thanksgiving in mine for Christmas— to close the book once and for all on the question of whether it’s possible to uphold the American holiday tradition of gluttonous overindulgence without eating animal products.
They were skeptical at first, but after enjoying seconds of my Brussels sprouts gratin, thirds of his mushroom-sage stuffing, and subsequently passing out on the couch only to awaken two hours later for one more slice of dairy-free pecan/pumpkin pie, we had them convinced: it’s not only possible to overdo it at a vegetarian Thanksgiving, it’s positively easy. As a yogi, I try to practice brahmacharya—sometimes defined as discipline over the impulse towards excess—but I am only mortal, and my self-restraint tends to fly out the window when confronted with garlic mashed potatoes.
All of which is to say, whether vegetarian, vegan, pescatarian or omnivore, most of us have a tendency to overindulge at this time of year. I teach at a college, and by the time I’m finished with the fall semester I have usually attended at least four work-related holiday parties, having managed to resist housing a bucketful of my colleague Professor Yao’s home-made Chex mix at exactly none of them. Brahmacharya is all well and good, but you know what’s also good? My friend Dave’s praline pecans.
If you’re anything like me, dramatically increasing your intake of sugary, fatty and processed foods tends to wreak havoc on your digestive system. We can’t put a halt to holiday fun (who would want to?) and I, at least, probably cannot stop myself for reaching for that second White Fudge Oreo (they’re only in stores once a year!). Thankfully, asana and yogic techniques are available to aid and improve our digestion, as well as mindfulness practices which can help us truly appreciate the sensory ritual of eating. Read on for five tips for improving digestion with yoga this holiday season.
1) Add Twists to Your Asana Practice
Let’s not beat around the bush: between the eggnog and the port-wine cheese balls, I tend to consume a lot more dairy than usual during the holiday season, which tends to, um, cause my inner elves to slooooow down production in the ol’ toy shop, if you take my meaning. In other words, I get constipated, and when I do, I make sure that my on-the-mat practice includes plenty of twists. Just make sure you’re doing them correctly to aid in… efficient toy production.
Twists aid in the movement of waste through your colon, as long as you begin by twisting to the right side. Starting this way targets the ascending colon, helping it to stretch and send waste across the transverse colon. Then, when you twist to the left, your body encourages the waste to continue on to the descending colon and finally into the sigmoid colon, where it becomes ready for elimination. Try incorporating parivritta ardha chandrasana (revolved half-moon) and parivritta trikonasana (revolved triangle) into a warrior sequence, or add parivritta utkatasana (revolved chair) into a standing balance sequence.
2) Boost Your Agni
Agni is the Ayurvedic term for “digestive fire” (meaning your body’s capability to digest food easily and completely). Undigested or poorly digested food results in the body’s production of a toxic by-product called ama, which inhibits immunity. (For more on agni, ama, and boosting immunity with yoga, refer to our post “Yoga Hacks for Allergy Season” here.)
Healthy digestion requires strong agni, and strong abdominals beget strong agni. Asana that target the abdominal muscles include phalakasana (plank pose) purvottanasana (upward plank) utthtita trikonasana (extended triangle) and virabhadrasana (warrior) III. Strengthening the lower back muscles will contribute to your core strength, so make sure that your on-the-mat practice includes plenty of vinyasas (adho and urdhva mukha svavasana are both excellent for increasing back strength) as well as danurasana (bow), salabhasana (locust) and/or setu bandha sarvangasana (bridge).
In addition, try practicing the pranayama/asana hybrid agni sara. Agni sara (literally “essence of fire”) utilizes the solar plexus, lower abdominals and pelvic floor muscles, stimulating the digestive system and aiding in proper elimination of waste. You can view a step-by-step guide to agni sara here. For beginners: start in sukhasana or malasana and contract the lower abdominals. Breathe deeply into the belly and pelvic floor, pulling the navel firmly towards the spine on the exhale and relaxing the belly fully on the inhale. Three rounds of ten breaths—ideally on an empty stomach—are sufficient.
3) Utilize Pranayama to Reduce Stress
Over-indulgence in rich or sugary holiday treats, alcohol and/or gluten and dairy can result in bloating as well as constipation. But bloating can also be a by-product of stress, and stress can inhibit effective digestion. There’s a reason the gut is often referred to as the body’s “second brain.” Acute stress directs blood flow to away from gut to the brain and limbs, and chronic stress can cause imbalances in beneficial gut bacteria, as well as inflammation.
There are many aspects of yoga that reduce stress, but deep belly-breathing in particular releases tension in the abdomen, allowing for increased blood flow and aiding in digestion, which in turn reduces bloating. A simple breathing exercise that targets the belly is Dirga Pranayama, or three-part breath. To practice Dirga Pranayama, find an easy seat with a straight back and a hand loosely placed on your belly. Inhale deeply and slowly, imagining that you are filling your belly, ribcage, and upper chest completely. Then exhale equally slowly, “deflating” the upper chest, ribcage, and belly. (Note: of course, you cannot actually breathe into your belly! But you can feel the sensation of breathing into your belly by practicing Dirga Pranayama, which in turn can help your abdominal muscles relax.) Another effective way to feel the breath drop low in the body is to find a comfortable child’s pose with relaxed arms, and inhale slowly with the intention of feeling the sensation of expanding your lower back with your breath. If it’s comfortable for you, separate your thighs so that your belly can “flop” between them.
4) Plan Ayurvedic Holiday Meals
Happily, Ayurveda already involves eating seasonally and regionally, and many of the traditional holiday dishes associated with Thanksgiving and other holiday meals are already based around fall harvest produce in North America. Yams, Brussels sprouts, carrots and other root vegetables are all in season in the autumn and can contribute to a balanced holiday meal while supplying nutrients without reducing agni. Even potatoes—sometimes regarded as a blanket no-no in Ayurvedic cooking—can take their part on your table, as long as you prepare them according to your dosha: add oil or other fat for Vata, limit fat and add warming spices for Kapha. Potatoes are basically neutral for Pittas, so go ahead and have that second scoop!
In addition to eating seasonally, keep your holiday meal Ayurvedically sound by including the six tastes: sour, salty, sweet, pungent, bitter and astringent. The fatty, moist recipes associated with Thanksgiving dishes will help to balance the dry, cold Vata season in which the holiday falls. Just make sure you include bitter, pungent, and astringent tastes as well, to balance the flavor and nourish the dhatus. Ayurvedic holiday recipes, including Thanksgiving favorites, can be found here.
5) Try Following a Sattvic Diet
Following a Sattvic diet at points throughout the year can certainly ease radical eating disparities during the holidays. In Ayurvedic philosophy, there are three qualities, or gunas, that exist in all of nature: rajas, tamas and sattva. With regard to nutrition, these qualities manifest as stimulating rajasic foods (spicy, salty, or bitter tastes), enervating tamasic foods (bland, heavy tastes, or anything artificial or stale) and purifying sattvic foods (fresh, calming, and easily digestible).
The term sattvic can refer to an entire lifestyle of intentional ritual, meditation and philosophy. Serious yogis will often maintain a sattvic diet for months or even years at a time, or undertake a sattvic cleanse, which can be intense and should be conducted under the supervision of a professional Ayurvedic practitioner. But we can all add elements of sattvic eating into our daily diets to improve digestion and wellbeing. Here are some simple suggestions to get digestion back on track after a holiday meal, keeping in mind that you may need to make adjustments if you are currently eating to balance your particular dosha:
• Eat fresh, organic produce. Try to base meals around fresh ingredients and whole foods.
• Eat less meat. Try beans and lentils as alternate sources of protein.
• Cut down on refined sugar and processed foods. Consider honey or molasses as an alternative to sugar.
• Reduce your intake of alcohol and caffeine. Alcohol is enervating, or tamasic, and caffeine is stimulating, or rajasic. Reducing both helps to bring the both mind and the gut into a balanced, calm sattvic state.
• Pay attention to where and how your food is prepared. Truly sattvic food is prepared in a pleasant atmosphere, with intention and love. While this might not be practical for every meal, especially if you frequently eat outside your home, you can start by making one sattvic meal day for yourself every day, such as a simple breakfast of whole oats, fresh milk, and some honey or fruit.
While brahmacharya is certainly a virtue, even the most disciplined among us can fall prey to the perils of holiday revelry, leaving our tummies to pick up the proverbial tab. Happily, whether we’re planning ahead or looking back in regret, yoga and Ayurveda offer plenty of tools for soothing and regulating digestion. So, bring on those special edition White Fudge Oreos! After all, they’re technically vegan, and this year I’ll stop after one. Or two. Definitely not more than three.
For an intro to Ayurveda, please join us for Prema Yoga Therapeutics Essentials February 7 -March 1, 2020, or for a more in-depth explanation in our annual Ayurvedic Yoga Therapy Therapy Training.
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Online Sources:
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Molly Goforth is a yoga and meditation teacher and a student at Prema Yoga Institute. She specializes in accessibility and trauma-informed yoga teaching and practice.
An Interview with Erin Moon, PYI Graduate and Director/Co-Creator of the World Spine Care Yoga Project
As a student in Prema Yoga Institute’s Yoga Therapy Certification program, I had the privilege of undergoing a 50 hour training in Functional Anatomy under the tutelage of Erin Moon, a certified yoga therapist and Prema graduate, and director and co-creator of the World Spine Care Yoga Project.
World Spine Care created the Global Spine Care Initiative (GSCI) in 2018 as a community project, to “reduce the global burden of disease and disability by bringing together leading healthcare providers, scientists, specialists, government agencies, and other stakeholders to transform the delivery of spine care.”
I recently had the opportunity to sit down with Erin and ask her some questions about her work as a yoga therapist in general and the Project in particular in advance of World Spine Day, which will mark its eighth year of official celebration on October 16th. What follows are excerpts from that conversation.
As a student in Prema Yoga Institute’s Yoga Therapy Certification program, I had the privilege of undergoing a 50 hour training in Functional Anatomy under the tutelage of Erin Moon, a certified yoga therapist and Prema graduate, and director and co-creator of the World Spine Care Yoga Project.
World Spine Care created the Global Spine Care Initiative (GSCI) in 2018 as a community project, to “reduce the global burden of disease and disability by bringing together leading healthcare providers, scientists, specialists, government agencies, and other stakeholders to transform the delivery of spine care.”
I recently had the opportunity to sit down with Erin and ask her some questions about her work as a yoga therapist in general and the Project in particular in advance of World Spine Day, which will mark its eighth year of official celebration on October 16th. What follows are excerpts from that conversation.
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PYI: What originally drew you to yoga therapy?
EM: It was a natural progression as the term came into greater recognition and regulation within the modern yoga community. I was grandfathered into IAYT partially because, like so many collogues, I had been and continue to work with every client with deep care and the approach of the holistic health paradigm that the ancient practices and philosophies of yoga provide. I felt it was important, as I furthered my education, to dive deeper into the intersection of the allopathic and holistic approaches to health and healing. As it does for so many others, the desire to deepen my training arose from personal trauma and the old adage “teacher heal thyself.”
PYI: While studying at PYI, what was your favorite module?
EM: I loved Yoga in Healthcare. In my 300hr training, before Prema, I focused on yoga and healing and then narrowed my focus to yoga and stress, specifically the neurobiology of stress. Yogic practices, I believe, work with stress in a very special way and provide our greatest opportunity for intervention through many, many tools. So getting a chance to learn from soma-psychotherapists, physicians and physical therapists who are also yoga therapists about what they have learned clinically was astoundingly enlightening.
PYI: When did you first begin to focus on spinal care?
EM: In 2015 I met the Clinical Director of World Spine Care (WSC), Geoff Outerbridge, at an adult sleep-away camp called Camp Good Life Project and we realized that we had a lot to talk about. He was developing an idea for a community Project for WSC that needed a teacher of yoga teachers with a strong anatomy and therapeutics background who happened to also have international volunteer experience (the flagship clinic is in Botswana, so being culturally aware and sensitive was very important). That is when I became the co-director/creator (along with my co-creator Barrie Risman and, since 2017, Jesal Parikh and Letizzia Wastavino) and particularly interested in Spine Care. However, the Yoga Project (YP) is not solely focused on Spine Care but also more generally on all musculoskeletal care, pain management, and active and preventative self-care.
PYI: Please tell us about the World Spine Care YOGA Project.
EM: I think the best way to start is with our mission and vision:
Mission
We are focused on building community capacity for low mobility populations by sharing the practices of Yoga as tools for management and prevention of musculoskeletal pain.
Vision
To globally inspire self-directed, self-led and self-sustaining communities, who experience low mobility, to use the practices of Yoga for active and preventative self-care and pain management.
We began in 2016 when Barrie Risman and I first rolled out the program in the flagship clinic in Shoshong (a village) and Mahalapye (a town) in Botswana. That first time, we worked with two different groups: one with higher mobility and one with lower mobility. We’ve since learned that the more mature group with lower mobility, who themselves benefited from the protocol, are the group that has kept the program going. They are also living in an area with a tighter community spirit. Because the Yoga Project is a community-oriented program, we learned, over time, how fundamental that tightly knit community is to the success of the program. They have taught us a lot and we have since gone back and offered level two of our protocol with more standing postures and breath and mindfulness.
Overall, this is how we function:
We work only with populations who have asked for a preventative/active self-care and pain management modal.
We work in our respective home countries and in global communities where World Spine Care has an existing presence with potential for expansion beyond WSC clinical modal into interested and supportive communities.
We train people who are interested in using the benefits of the Yoga Project protocol to contribute to their community and themselves.
We adapt to the individual needs of the communities we are working with; cultural norms and practices are incorporated into the program, i.e. dance, song, physical appropriateness of postures, posture names, etc.
We are a secular program, meaning that we are open to the beliefs of all the communities we serve and happily encourage worship where appropriate, but we do not come in with any religious overlay or agenda. We also teach that the history of the practice’s roots come from India and that there are many more practices, not included in the Yoga Project protocol, that can be explored individually.
We adapt the Yoga Project protocol as new information about mobility, physiology and psychology is made available to us through research.
We offer practices of mindfulness based upon research concerning mindfulness-based stress reduction and the 3000 years of Yogic practices for pain and stress management.
We offer practices of breath based upon vagal nerve research, etc., and the 3000 years of Yogic practices for pain and stress management.
We offer poses that explore stable, long-term, functional range of motion for lower mobility populations. We encourage adapting to offer low too no pain- movements to those experiencing pain.
We offer multiple levels of trainings as is appropriate for different levels of mobility and pain. Currently our offerings include: a level one training with a larger percentage of chair supported postures and a level two training with more standing postures and greater physical challenge.
We also offer our programs to MD, PT, OT and chiropractors as well as trained yoga instructors as continuing education to better serve their communities and patients.
We are an online resource for low mobility and pain populations world wide for at-home practice and capacity-building, using the practices of Mindfulness, Breath and Posture.
PYI: We understand that you train teachers in Botswana. Have the Botswana teachers found specific spinal needs in their communities?
EM: They themselves are dealing with a host of different spinal and musculoskeletal issues, pain and bio-psycho-social factors. We do not encourage or have time to specifically train our teachers to work with each different type of malady. Every issue they see and we have seen is multifactorial. The program is focused on keeping people mindfully active and offering stress management tools to help with pain management. Also, because we include such things as good biomechanics for getting in and out of a chair, seated posture work, etc., we are offering day-to-day applications of mindful movement. Basically, instead of working with individual conditions, we focus on mindfulness and svadyaya (self-reflection) as tools for choosing and working with movement that “feels good”.
Statistically, the most affected populations with chronic (long-lasting) pain due to musculoskeletal and specific spinal issues are women over 50 in developing nations, due to a host of reasons ranging from access to good health care options and self-care education to highly labor-oriented lifestyles (though that is never to say that someone who sits all day at work will suffer less pain). It is always a complicated mix of elements that includes: which musculoskeletal issues and pain issues arise as well as the bio-psycho-social factors in any given population, so I want to be careful about being too reductive.
That being said, here is a little bit from WSC website to help:
The Global Burden of Disease report was published in Lancet in December 2012 (Murray et al, Vos et al, 2012). In this report, the following information regarding spinal conditions was reported:
• Low back pain is the leading cause of disability.
• Neck pain is the fourth leading cause of disability.
• Low back pain and neck pain affect 1 billion people worldwide.
• Spinal pain contributes more to the global burden of disease (including death and disability) than: HIV, diabetes, malaria, stroke, Alzheimer’s disease, breast and lung cancer combined, traffic injuries, and lower respiratory infections.
PYI: In the recent past in America, yoga has been mostly available and marketed to a more privileged group of students. How do you suggest we work to diversify to provide yoga for all?
EM: Well, this really is the question! It certainly is on my mind all the time. I cannot propose to have the answer, though, because for me, I feel it is time to really listen, to ask questions and get curious, to listen again and then listen again and then to stand beside rather than in front of the voices that are rising in our community about intersectionality and inclusion. Perhaps through this process things will change: through good, true allyship.
The question I pose to any yoga business is this: what face, body, ability and/or sexual identity are you representing in your teaching staff and in your advertisements? How are you creating a sangha that feels safe and accessible to all the bodies you hope to serve in your community? Who is in your community? Have you asked what they want? If it is not a visible shift, I don’t think a shift can actually happen. If it is not a fundamental values shift, I don’t think a shift can happen.
PYI: Do you have any advice for therapeutic yoga teachers wishing to start their own not-for-profit initiative?
EM: Ask questions, listen and go slowly. Do not think you know what a community needs because something has served you or “the research says” or “the tradition says”. Listen to what people are actually asking for: what their bodies and hearts and minds are asking for. Be open to learning and adapting. Ask, observe, adapt and then ask again!
PYI: How can we donate to your initiative?
EM: On this page you can specifically donate to the Yoga Project. You can find us on Facebook and Instagram @worldspinecareyogaproject, where we offer pain management tools and active self care from our protocol.
If you are an MD, PT or YT and want to do a Work-A-Day for WSCYP on the 16th in honor or World Spine day, follow this link.
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It was truly an honor to spend time with Erin and learn about her important and groundbreaking work incorporating yoga therapy into the work of the World Spine Care—the PYI community extends its thanks and appreciation to her and the healthcare professionals and dedicated communities with whom she works. We look forward to offering you more interviews and insight on the exciting work being done by our students and graduates in the coming months.
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Erin Moon, C-IAYT, is the lead teacher of Functional Anatomy 1 and a Mentor at PYI.
Molly Goforth is a yoga and meditation teacher and a student at Prema Yoga Institute. She specializes in accessibility and trauma-informed yoga teaching and practice.