Why Bring Yoga Into Healthcare?
Some of you have wondered why YogaX is dedicated to bringing yoga into healthcare, one teacher at a time. We thought it was time to give you the big picture about why we believe that yoga offers a unique and innovative solution to some of the challenges that are facing healthcare today. We are excited to share that yoga has benefits for patients and their families, providers and their communities, and possibly even healthcare systems overall because, at its heart, yoga is a lifestyle that promotes prevention, resilience, and wellbeing.
Extant Challenges in Healthcare
Given the rapidly evolving healthcare landscape and the numerous healthcare systems challenges that have emerged in response to a multitude of cooccurring recent events, innovation and integrated holistic approaches are becoming imperative for achieving exceptional patient outcomes, optimized resource utilization, and a resilient healthcare workforce. Healthcare is often fragmented, discontinuous, stigmatizing, and siloed with some care providers dedicated to matters of body, others to matters of mind, and other to matters of behavior and relationships. Rarely do patients or clients encounter providers who are interested in the entirety of a patient’s life – their intentions, thoughts, speech, actions, behaviors, and relationships – in the context of their biopsychosociocultural circumstances. Contacts with care providers are often disempowering, leaving patients out of engaged decision-making and leading to con-compliance with treatment – sometimes due to a lack of understanding of the recommendations or perhaps even more often due to inadequate resources to follow through with suggestions that patients cannot afford. Access to care is limited in general and even more difficult for people of color or individuals who are non-English speaking. Systems continue to ignore and fail to address social and cultural determinants of health, making standard treatments inappropriate, inaccessible, even irrelevant for many. Costs for countless services make access near impossible for many and provider shortages mean delays in getting appointments for any presenting concern that is not urgent or emergent.
For providers, healthcare systems have become stressful and isolating. Patients need to be seen rapidly and notes need to be written while sitting with a patient, highlighting the increasingly impersonal interaction between provider and patient. Productivity demands are increasing and collaboration or consultation with colleagues is becoming less common. Care is not coordinated across providers as time does not allow for close collaboration and incompatible health information systems fail to allow for easy and streamlined communication. Provider shortages are overwhelming and overwork contributes to preventable medical errors. Systems are looking for quick fixes for symptoms rather than being dedicated to primary and secondary prevention of disease, illness, and suffering to begin with – ignoring the biopsychosociocultural context in which suffering arises. Fiscal realities are crowding out caring relationships; pharmaceutical industries are suggesting that every problem can be fixed with a pill or potion; insurance companies impose requirements about care leaving healthcare providers feeling out of control and out of sync with their patients.
Healthcare systems are preoccupied with disease care – reactively responding to suffering that is already present with little or no strategic vision about how to prevent many illnesses before they arise. In the meantime, human beings are suffering. They are experiencing chronic physical health, mental health, and behavioral health-related conditions amenable to primary and secondary prevention through health behavior changes that are often related to lifestyle and either lack of information or misinformation about what it takes to be healthy physically, emotionally, mentally, behaviorally, and relationally.
Yoga and Healthcare
Integration of yoga into healthcare settings presents an innovative and multifaceted opportunity to revolutionize at least some of the challenges within current healthcare systems. Yoga’s core principles are uniquely aligned with a commitment to comprehensive, coordinated, and integrated person-centered preventive and supportive care while enhancing provider wellbeing. The integration of yoga’s ancient wisdom into modern healthcare can create a more resilient healthcare ecosystem that places emphasis on integrated and holistic wellbeing and lifestyles for patients and care providers alike.
Yoga, as an integrated holistic lifestyle practice, attends to and works with all aspects of what it means to be human – body, vitality, breath, mind, cognition, emotion, behavior, relationships, community, spiritual practice, and more. Yoga’s mindful movements and postures maintain and improve flexibility, strength, and balance; support functional movement and injury prevention; can enhance postoperative care; and provide physical strategies for pain and chronic disease management. Breathing practices offer stress-reduction techniques that help regulate the nervous system, reduce perceptions of stress, and support emotional regulation; they promote greater vitality and ease in general and during periods of challenge in particular; they can become key features in enhancing emotional and mental wellbeing, coping, and resilience. Inner practices, such as concentration and meditation, further foster mental and emotional resilience; support enhanced health behaviors, such as sleep, agency, empowerment, and realistic self-assessment; transform interpersonal relationships and invite community; and offer strategies for wise discernment or decision-making as well as wholesome life and lifestyle choices.
Patients who are engaged in a yoga practice have been shown to experience enhanced life satisfaction and well-being, as yoga has been associated with improved quality of life, reduced anxiety, and enhanced coping. Integrating yoga in healthcare systems has resulted in bolstered patient satisfaction scores and more patient-centered approaches. Healthcare professionals who practice and refer to yoga might experience enhanced resilience, reduced risk for burnout, and healthier work-life balance. A resilient and rejuvenated healthcare workforce may experience improved job satisfaction and retention rates, and ultimately, will provide better care.
Perhaps most promisingly, the integration of yoga into extant healthcare systems can usher in a cultural shift and system change toward more integrated approaches to healthcare. Offering yoga in the context of healthcare is an investment in primary and secondary preventive care for the whole person (whether patient or provider) – preventing health, mental health, and behavioral health challenges, as well as mitigating long-term healthcare expenses through promoting health behavior and lifestyle changes. By proactively encouraging wise choices and committed self-care for body, vitality, mind, behavior, relationships, and communities, yoga may help reduce overall healthcare costs by preventing hospital admissions, decreasing medication reliance, and alleviating human and systems burdens of chronic conditions.
Benefits of Yoga in a Healthcare Settings
Benefits For Patients
Yoga as practiced therapeutic and wisely is a lifestyle. It integrates a multitude of practices, addresses humans in their entirety (body, mind, emotion, heart, relationships, and more), and pays attention to each person’s unique biopsychosociocultural context. Yoga may be the original lifestyle medicine strategy, as ancient as 2,500 years. In the modern western world, lifestyle medicine has emerged recently as a field focused on values-based care, promoting health, preventing illness, managing chronic diseases, and encouraging healthcare systems and providers to see their patients as whole people with complex needs regardless of the specific presenting problem in the moment. Lifestyle medicine seeks to transform siloed care and to bridge the false dichotomy of mind versus body that is so prevalent in conventional healthcare. Lifestyle medicine practitioners argue that by addressing six important lifestyle “pillars”, that – if integratively and holistically attended to by healthcare interventions – can be transformative for patients’ (and their families’ and communities’) health and wellbeing. Yoga has something to offer with regard to each of these aspects of being human and as such is an existing and helpful lifestyle medicine strategy that can support the whole person – patient and provider. A well-trained yoga teacher who understands this link between lifestyle medicine and therapeutic integrated holistic yoga can become the perfect individual for a warm handoff of a patient from a busy medical provider. Integrated holistic yoga providers understand how to support, coach, and encourage patients to take charge of health behaviors that moderate risk and enhance wellbeing.
Important Note: In the discussion below, the word “pillar” is avoided and “aspect” is used instead. Thinking of these 6 areas of interest as aspects of one whole and integrated human being seems more in line with yoga than the notion of pillars, which may suggest silos or separate issues. The reality is, these six aspects of human functioning are entirely interwoven and interdependent. They cannot and should not be addressed independently of one another. In fact, many of the same yoga strategies will address multiples of these aspects of human functioning.
Aspect 1: Nutrition
The first aspect lifestyle medicine emphasizes a whole-foods, plant-based diet rich in fruits, vegetables, whole grains, and lean proteins, while minimizing processed foods, added sugars, and unhealthy fats. It addresses healthful nutritional choices and practices, including mindful eating.
Sample Yoga Practices
Many yoga practices have direct and indirect impacts on nutritional choices and eating habits. Yoga practices can be used to help teach discernment about which types of foods appear to be most nourishing and supportive for physical, mental, and emotional wellbeing. Yoga can also help with developing skills that lead to more mindful food choices, communal eating, culturally-based meal traditions, and the integration of ethical decision-making about which types of food to eat.
Ethical and lifestyle practices: can help clarify food choices, impacts of nutrition, non-harming and moderate food consumption, food-related behavioral choices, and more
Asana (posture) and kriya (movement coordinated with breath) practices: can improve metabolism, enhance digestion, and promote weight management; cultivate interoception which supports recognition of the body’s responses to external and internal influences, including responses to food and drink and the way they are ingested
Breath awareness practices: can help develop a healthy relationship with food and reduce emotional eating; cultivate interoception and awareness of the effect of certain foods on vitality; support recognition of effect of food and drink on energy and affect
Mindful eating practices: encourage paying attention to the taste, texture, and aroma of food; can help prevent dysfunctional and stress eating; may improve digestion; improve discernment about which foods and drink serve wellbeing and which promote ill health; encourage conscious consumption that transcends food and informs other transactional choices and behaviors that ultimately determine individual and collective health
Aspect 2: Physical Activity
The second aspect of lifestyle medicine addresses regular exercise and varied activities as ways of enhancing overall well-being, preventing metabolic syndrome, improving cardiovascular health, and maintaining healthy weight. Consistency and variability in movement is particularly helpful, including practices for balance, strength, mobility, endurance, and more. Functional movement is key, as it takes exercise and translates it into movement in daily living.
Sample Yoga Practices
Yoga integrates many types of movement and can be tailored to address individual needs by focusing on particular aspects of movement that are especially needed. Yoga can be used to encourage a physically active and mindful lifestyle that takes physical learning off the mat and into life. Yoga movement practiced in the true spirit of yoga is neither fitness- nor exercise-oriented (which are false Western stereotypes and emphases about yoga) but instead leads to embodied presence, compassionate mindfulness, and personal self-regulation that supports emotional and cognitive health and wellbeing. Yoga’s physical practices can be adapted by skillful and therapeutically trained yoga teachers to support patients of all abilities and those recovering from surgeries, injuries, or other conditions with positive and supportive effects on strength, balance, and mobility. Such physical practices are grounded in student needs and intentions, and offer patient-centered variations and adaptations.
Asana and kriya practices: can help improve mobility, strength, coordination, and overall physical wellness; increase proprioception and balance; tend to increase enjoyment of movement that emerges from within the person based on in-the-moment interoception and self-expression
Vinyasa and kriya practices: can provide cardiovascular and respiratory benefits; support movement with intervals of moderate to high intensity, alternating with rest and recuperation; create physical resilience and interoception
Pranayama practices: optimize breathing during movement, in general, and during exercise, in particular; enhance respiratory resilience and tissue oxygenation; can help prevent exercise-induced asthma
Aspect 3: Restorative Sleep
The third aspect of lifestyle medicine prioritizes sleep as a crucial necessity to cultivate overall health and well-being. It addresses the need for both optimal quantity and quality of sleep for a population that tends to be sleep-deprived, sleeps fitfully, or faces significant sleep disorders. Restorative sleep is essential for long-term memory consolidation; attention, focus, and concentration; and physical rest and restoration.
Sample Yoga Practices
Practicing yoga can help patients with many types of sleep disorders or insomnia via a variety of practices. Some practices are helpful because they address dysfunctional breathing that can interfere with sleep and/or contributes to disorders such as sleep apnea. Some yoga practices promote relaxation and provide techniques to calm the mind before bedtime. Careful breathwork can teach individuals how to breathe optimally in daily life and under specific situational demands.
Ethical and lifestyle practices: can help clarify lifestyle choices that either promote or hinder sleep (e.g., attention to environmental stimuli; food choices, especially before bedtime; light-dark cycles and impact of blue light; daily rhythms); support lifestyle changes of discipline and moderation that help with more restorative sleep and healthier sleep patterns
Yoga nidra and related practices: promote deep sleep and calm brainwave activity; alter stress perceptions; calm the mind (both thoughts and emotions) for sleep
Restorative yoga practices: calm the mind and guard the senses from excessive stimulation; restore resilience through engaging the vagal brake and calming the sympathetic nervous system response; help create access to restful stillness
Pranayama practices: help relax and balance the nervous system; promote optimal functional breathing that reduces interferences with sleep, such as snoring or apnea; provide strategies for calming and stress reduction, in general, and at bedtime, in particular
Sense-guarding practices (including savasana): calm mind activity (i.e., thoughts and emotions); create mind states that are supportive of restful sleep; bring greater calm to daily life by teaching discernment about environmental stimulation
Aspect 4: Promotion of Resilience
The fourth aspect in lifestyle medicine, often referred to as stress management, is the promotion of resilience as essential to supporting patients’ capacity to deal with stressors (both positive and negative) of daily living, thus mitigating risk for lifestyle-related illness. Chronic perceptions of stress contribute to various health issues including, but not limited to, chronic illness, pain, addictions, anxiety, and other health, behavioral health, and mental health challenges. Enhanced resilience is beneficial for patients already dealing with chronic illnesses or undergoing medical treatments.
Sample Yoga Practices
Yoga incorporates many practices that reduce perceptions of stress and enhance resilience during and after challenging situations. Yoga practices promote emotional regulation and calm the nervous system. Yoga strategies invite practitioners to develop mind sets that help them see obstacles as opportunities, that increase the capacity to problem-solve, and that support growth and evolution. Yoga strategies can be viewed as stress inoculation and as such are truly offered in the spirit of primary prevention.
Ethical and lifestyle practices: support introspection, self-inquiry, ongoing learning and curiosity that help transform mental habits and mind set; support active health behavior change; assist with values clarification and the development of new and more wholesome lifestyle behaviors of resilience and effective coping; help cultivate gratitude and compassion
Restorative movement and kriya practices: help body and mind become more resilient and flexible as they invite exploration and transcendence of habits; invite the formation of new ways of moving and thinking; offer opportunities to explore and observe natural physical and mental recovery after challenge in body, breath, mind, and emotions; create difficult situations while offering engagement in strategies for mastery to promote development of self-efficacy and agency
Pranayama practices: invite resilience and flexibility in emotional responsiveness; promote increasingly functional breathing skills that support a calm and collected mind during moments of stress; can be applied in ways to demonstrate recovery after challenge; can offer practices of hormesis, using temporary dysregulation to explore and experience capacity for recovery
Meditation and concentration practices: help reduce perceptions of stress; promote mental clarity; invite mindfulness and insight about mental activity that contributes to distress; alter dysfunctional mindsets to invite wholesome mindsets (e.g., growth mindsets); cultivate practices of gratitude, compassion, joy, and lovingkindness – all directly related to greater resilience and enhanced perceptions of happiness
Aspect 5: Social Connection
The fifth aspect of lifestyle medicine acknowledges the profound human need for social connection and interpersonal embeddedness in relationships that nourish, support, and enrich development across the lifespan. Building and maintaining meaningful relationships has proven positive impacts and physical, mental, emotional, and behavioral health.
Sample Yoga Practices
Yoga psychology is deeply based in the interconnection of human beings and their lack of capacity for living in isolation. It acknowledges the profound human need for social support and guidance to develop physically, affectively, mentally, emotionally, cognitively, behaviorally, and relationally in ways that result in personal and collective wellbeing. Many yoga practices integrate collectivism and promote togetherness, compassion, lovingkindness, and expressions of gratitude; they promote behaviors and actions that enhance relationships and communities. The importance of yoga’s community-building cannot be overstated given the epidemic of social isolation and loneliness in an increasingly (post-COVID) virtual world.
Ethical and lifestyle practices: strongly promote values of nonharming, truthfulness, gratitude, and compassion; are foundational to all yoga practices by anchoring practitioners in a sense of collective purpose; create intention for the practice that enhances and promotes personal wellbeing as well as the greater good for all; cultivate deep commitments to purpose that is oriented toward the greater good
Group-based movement and breathing classes: foster a sense of community and connection through shared movement, shared breathing, and shared meditation practices; help students become aware of shared experience and co-regulation
Partner movement practices: enhance trust and communication skills in relationships and at the community level; increase awareness of co-regulation and mutuality; increase collaboration and coordination of skills; support compassion, lovingkindness, and altruistic joy
Meditation practices: enhance commitments to compassion and lovingkindness; help develop intentionality, mindfulness, and purpose in relationships and communities; raise awareness of shared suffering and the mutuality of shared practice; invite equanimity and co-regulation in light of challenge; cultivate regular practices of compassion, altruism, lovingkindness, altruistic joy, and gratitude; refine the practice of equanimity and proactive acceptance
Aspect 6: Avoidance of Risky Substances and Addictive Behaviors
The sixth aspect of lifestyle medicine is concerned with supporting health by helping individuals understand the risk of using, ingesting, or working with risky substances. It promotes the avoidance or moderate use of tobacco, alcohol, and illicit drugs as essential for maintaining good health. It deals with developing supports for addiction and dependence to such substances, as well as to prescription medications (including opioids). It can also concern itself with exposures to toxins, such as dangerous chemicals in foods, cosmetics, and cleaning products.
Sample Yoga Practices
Yoga promotes lifestyles of intention, mindfulness, and discipline that support habits that increase awareness of the risks of the many toxins to which humans are exposed across their lifetime. They invite individuals to become more mindful of toxins in their environment (via cosmetics, cleaners, food, drink, medications, and drugs); they prevent or help with recovery from addictions. Yoga’s diverse practices overall can help improve mental wellbeing by reducing symptoms of depression, enhancing emotional resilience, and promoting a positive outlook. By enhancing mental health, the risk for addiction can be reduced. Similarly, yoga practices can help manage and alleviate chronic pain conditions like back pain, arthritis, and headaches – further reducing and managing risk for developing substance dependence, including dependence on prescribed medications. Yoga also supports the removal of toxic influences, including eliminating over-stimulation of the senses, mindless consumption, and other behaviors that lead to non-substance-based addictions.
Ethical and lifestyle practices: promote values of nonharming, moderation, purpose, and intention; encourage self-study and education to understand risks and benefits of health behaviors; invite lifestyles that reduce risk for harm and increase likelihood of wellness; support discerning choices about food and drink; encourage purity for self, home, environment, and planet; invite the elimination of overstimulation via many modern habits, such as those related to the use of devices, TV, movies, shopping and more
Asana and kriya practices: provide strategies for lifting mood and enhancing resilience; increase recognition of personal capacity for self-regulation; empower and uplift, thus reducing the need for other types of stimulants/stimulation or mood changing substances or actions; enhance interoception and exteroception, gaining appreciation of the effect of outer stimuli on body and energy
Pranayama practices: increase capacity for emotional and affective self-regulation and mitigating the risk for using external supports (e.g., drugs, medicines); promote top-down executive control and discerning choices
Pratyahara practices: increase awareness of harmful habits and sensations, fostering self-control; increase agency and empower wise choices, especially related to managing stimulation of the senses; enhance interoception to increase awareness of inner responses to outer influences, including substances and stimuli
Meditation and mindfulness: increase self-awareness and executive control; support responsiveness over reactivity; increase the gap between stimulus and response; anchor humans in healthful decision-making for enhanced personal and collective wellbeing and health; encourage recognition and transcendence of habits, repetitive actions, and relational or mental vicious cycles
Benefits For Healthcare Providers and Settings
Honoring the Mind-Body-Heart-Community Connection
Healthcare providers who are knowledgeable about yoga and its principles can better understand the mind-body-heart connection and its implications for patient health, leading to more holistic and effective care. They understand the layers of complexity with which humans present – honoring their physical, vital, mental and emotional, wise and intuitive consciousness. They recognize the embeddedness of humans in community and context, and thus can begin to select prescriptions (including behavioral prescriptions) and intervention that honor this context and background. They avoid reductionism and see complexity; they honor interconnection and avoid objectification. They honor relationship and avoid impersonal interactions that disavow humanity.
Diversifying Treatment Strategies
Integrating yoga into healthcare can provide an additional tool for healthcare providers to offer care that complements medical treatments and therapies. Patients can be referred to therapeutic yoga providers who will offer support with identifying optimal functional breathing, breath strategies that lend support in particular circumstances; lifestyle choices that create intention and purpose and that improve sleep, nutrition, community, actions and relationships, and choices about toxic exposures; activity choices, functional movement, and tailored exercise; mindfulness and concentration strategies for clearer minds; meditation for emotional, mental, and relational wellbeing; intervention that create community and connection, as well as co-regulation, compassion, lovingkindness, and shared joy. Diversified treatment strategies are more likely to be considerate of patients’ biopsychosociocultural context, honoring their preferences in relationships, behaviors, beliefs, and attitudes.
Enhancing Patient Engagement
Recommending yoga to patients encourages them to actively participate in their own health and well-being, leading to improved patient engagement and adherence to more individually-tailored, person-centered treatment plans. Individuals who engage in yoga become the agents of their own wellbeing, taking charge of creating purpose and intention, modifying lifestyles, integrating functional breathing and movement on the mat and off the mat, and caring for self and others. Patients are invited to bring auspicious health behaviors and choices into their life, relationships, families, and communities in proactive and resilient ways that help them feel empowered, supported, needed, and understood.
Supporting Provider Wellbeing
Regular yoga practice can contribute to overall wellbeing, potentially reducing the risk of various chronic diseases and promoting healthy lifestyle habits. The primary and secondary prevention function of yoga can serve patients and providers alike. Healthcare providers can benefit from practicing yoga, as it can help alleviate perceptions of stress and burnout, improve focus, and enhance overall mental and physical well-being. The pillars of health that are supported by yoga practices are equally preventive and wholesome for providers as they are for patients. The wellbeing and empowerment focus of yoga can help care providers get back in touch with their own sense of agency, their humanity, and their connection to a greater community. Mindfulness, commitments to compassion and lovingkindness, optimal functional breathing strategies, and mental reset strategies can provide quick in-the-moment interventions for healthcare providers in the midst of stressful interactions with patients, colleagues, and administrators.
Reducing Healthcare Costs
By incorporating yoga and other mind-body practices, healthcare providers may observe improved patient outcomes, which could lead to reduced hospitalizations and healthcare costs over the long term. The primary and secondary prevention functions of yoga will improve patient and provider wellbeing, reducing healthcare costs through improved lifestyle behaviors, enhanced personal agency and empowerment, and wholesome decision-making and discernment about life choices.
Training Needs of Yoga Professionals in Healthcare
While yoga offers numerous benefits, its integration into healthcare settings requires proper training, preparation, and credentialing for the yoga service providers and the referring healthcare professionals to make sure that the yoga being offered to patients appropriately addresses and supports their needs given their medical and mental health conditions. Healthcare providers and yoga instructors need to collaborate to tailor referrals and practices to patients’ needs, thus optimizing their safety and wellbeing. Specialized yoga teacher training programs for yoga clinicians who want to work in healthcare are imperative. Settings that want to bring yoga teaching into their integrated service offerings need to become educated about yoga teacher credentialing and need to make wise choices about which yoga teachers to hire.
YogaX’s teacher training programs (YTT 200hr or YTT 300hr) are specifically designed to prepare yoga teachers to offer their services in healthcare settings. Graduates from YogaX teacher training programs are often healthcare providers themselves and are well prepared to meet the challenges of healthcare settings in their teaching. They are well prepared by YogaX teachings to make yoga practices accessible, intentional, and beneficial by meeting the specific needs of the patients in their classes and in their care. They learn how to address the whole person – body, mind, spirit and more – and how to tailor chosen preventive and therapeutic strategies to specific needs and biopsychosociocultural contexts. They learn to draw on the vast tool box of yoga (including movement, breathing, concentration, meditation, community-building, values clarification, compassion training, gratitude practices, and more), augmented by modern scientific evidence. They recognize the need for close collaboration with other healthcare professionals to assure that all services are integrated and holistic, tailored to each patient and their life circumstances. They understand the need for wrap-around care that is rooted in provider collaborations and patient voices. They empower, invite agency, and offer choices.
With hope and faith in the continuing evolution and transformation of our healthcare systems and with best wishes for wellbeing and resilience among and the deepest gratitude for our intrepid healthcare workforce –
Chris
About the Author:
Christiane Brems, PhD, ABPP, E-RYT500, C-IAYT, is the Director of YogaX, a clinical psychologist, registered yoga teacher, certified yoga therapist, and certified Buteyko (breathing) Teacher. She has practiced yoga for over 40 years. You can read more about her on the YogaX Team page.