HEART Insight:
doi: 10.1097/01.HEARTI.0000300687.42008.63
Departments: Fit & Happy

Strike A Pose

Carr, Coeli

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Abstract

Don't Twist Yourself Into Knots Finding A Yoga Style For Your Fitness Goals

Millions of people have discovered the feel-good benefits of yoga, but not everyone realizes that practicing this ancient discipline can also promote and maintain cardiovascular health. Any physical activity that helps reduce stress or allows blood to flow through vessels more efficiently may be good for the heart. The good news is, yoga does both.

Two groundbreaking studies published in the medical journal The Lancet more than 30 years ago suggested that yoga could moderate high blood pressure. In the first study, after people who practiced the Savasana (deep relaxation) pose had been monitored with a biofeedback device for three months, researchers noted an average drop of 26 points in systolic (the top number) blood pressure, and a 15 point drop in diastolic pressure (the bottom number). A follow-up study a year later showed that the overall blood pressure of those who had kept on doing yoga remained lower than before the study began.

More recent research bears out these earlier findings. In a 2006 study published in Clinical Cardiology, participants who took a course in meditation and yoga and continued to practice both disciplines at home showed significant reductions in blood pressure and heart rate. And a study published last year in Clinical Journal of Sport Medicine found that physical activity either alone or combined with relaxation exercises decreases systolic and diastolic blood pressure.

Evidence this impressive should be enough to send everyone with a heart condition scurrying for a yoga mat. But once you've made up your mind to try yoga — or to graduate to a more challenging style — there are several things to keep in mind as you explore your options.

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GOING TO THE MAT

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“There's this misconception that all yoga's the same thing,” says Timothy McCall, M.D., a teacher and researcher on the therapeutic benefits of yoga who lives in Oakland, CA. “People often think that if yoga is relaxing, they can just turn up at any random yoga class, and it's going to help them,” adds McCall, who wrote Yoga As Medicine: The Yogic Prescription for Health and Healing (Bantam, 2007). Some yoga classes are enormously strenuous, he explains, and are inappropriate for people who have serious illness.

Some patients still have a ‘60s image of yoga — people standing on their heads, for instance, notes Nieca Goldberg, M.D., medical director of the New York University Women's Heart Program. “People perceive you need to be acrobatic to do the positions, which is very intimidating to people who are just starting out or have arthritis,” says Goldberg, who is often asked if yoga is good for the heart. It's not a question she can answer without first determining how physically fit a person is, and whether he or she can handle some of the more challenging types of yoga. “The good news is there are many different types of yoga and that it's a physical activity that's inclusive, rather than exclusive,” says Goldberg, the author of The Women's Healthy Heart Program (Ballantine, 2002).

Your first step is to talk to your doctor — but it's not enough to say “I want to do yoga,” cautions McCall. Your doctor may not know the difference between a soothing style, and one that involves a demanding aerobic routine. So show, don't tell. Brochures with written descriptions of yoga poses, and terms like “basic,” “intermediate” and “advanced” won't give your doctor a clear idea of what he or she is signing off on, so McCall suggests taking along a book that illustrates the poses you'll be doing.

You will also find a lot of variation in the intensity level of each yoga style, depending on the teacher, the level of the class and the yoga studio or health club. “It's not cut and dried,” says McCall, who urges people to do their homework.

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PRETZEL ILLOGIC

Just to be on the safe side, before trying out a class, call the yoga teacher or studio and discuss your health issues — “I'm thinking of coming to your class, and I get angina sometimes. I'd like to know if you think this class would be appropriate for me” — and ask about alternative styles if a particular class is not appropriate.

Be a tortoise, not a hare. Don't be one of those people who “push too hard and want results right now,” says McCall. “They don't want to relax and do the restorative poses [less strenuous, with pillows or bolsters used to maintain proper form] which they feel are a waste of time. They want ‘a good workout’ and to squeeze in as much bang for the buck as they can.” Says McCall: “It's okay to relax [and] monitor your breath. You don't have to maximize your aerobic benefit every second.”

Peer pressure can also prompt some to overexert — typically because he or she is in the wrong class. If you're in a group with people half your age who are highly athletic, you might feel inclined to push yourself to stay apace, warns Richard Usatine, M.D., professor of family and community medicine at the University of Texas Health Science Center at San Antonio. Usatine co-founded the yoga curriculum at the UCLA School of Medicine in the late 1990s that showed medical students how yoga could help them and their patients maintain and improve health.

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Overdoing it can lead to muscular injury, adds Usatine, who is a co-author of Yoga Rx: A Step-by-Step Program to Promote Health, Wellness and Healing for Common Ailments (Broadway, 2002). “If people overdo it in yoga class and wind up injuring themselves, they might become discouraged and not return to class,” says Usatine. “The trick is to start at an appropriate level and move up to more demanding styles as you become more adept.”

“People who do yoga gradually get happier and less angry, and they develop more equanimity,” says McCall, who speaks from experience. “One of the biggest things I noticed, after about a year of regular practice, was that stuff just didn't get to me as much, especially the little things, like waiting on lines or getting stuck in traffic.”

“Yoga makes you feel better, and when you feel better, your stress level is reduced,” he adds.

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Om-My-Gosh: So Many Yoga Styles!

Although there is no research that directly matches a particular yoga style to a specific health benefit, even the gentlest disciplines may contribute to heart health through stress-reduction. And one thing all yoga styles have in common is breath control — engaging the lower abdominal muscles when exhaling to squeeze residual air out of the lungs, allowing for a deeper intake of oxygen on the next inhale. “When you take slower, deeper breaths, you tend to activate the para sympathetic nervous system, which relaxes you and lowers stress levels,” says yoga practitioner Timothy McCall, M.D. He suggests these yoga styles, based on your level of fitness and cardiovascular health:

Meditation: Meditation springs from and is deeply connected to the heart of yoga, says McCall. Some low-exertion yoga styles include meditation and breath control. Whatever technique is used — being mindful of the breath while focusing on a word or an image, or clearing your mind of distracting thoughts — meditation can be healing. McCall notes that some students, especially type-As, give the meditation portion of yoga practice short shrift. “Going against the grain and calming your nervous system — meditation is good at that.”

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Low Exertion: “Relaxation” in Sanskrit is most closely translated into English as “loosening” — as in releasing the body of all effort or tension. McCall generally favors slower, more relaxing and more restorative forms of yoga for people with heart disease. Other mildly exerting styles are Integral, Kripalu, gentle Hatha and Viniyoga. Viniyoga, which is becoming increasingly popular, emphasizes the flow in and out of each position and into the next position, rather than alignment and holding positions.

Moderate Exertion: Iyengar, Anusara and Kundalini include more demanding poses that are held for a minute or more. While a low-exertion style such as Integral might involve shrugging your shoulders up or down, attention to form is important in a moderate-exertion style. For instance, you may be balancing on one leg while the other leg is in the air. It can be strenuous, notes McCall.

High Exertion: Ashtanga, Power Yoga and Bikram are all vigorous — and Bikram classes are conducted in heated rooms. Either way, you'll be sweating -— a lot. The combination of intense exertion and high heat and/or humidity, puts increased demand on the cardiovascular system, so these yoga styles may not be appropriate for people who have been diagnosed with heart disease, warns McCall. “If you sweat a lot, you can become dehydrated, which itself can be hard on the heart,” he adds.

© 2007 American Heart Association, Inc.

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