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Mind-Body (Mindful) Exercise in Practice

La Forge, Ralph M.Sc., FNLA, CLS

ACSM's Health & Fitness Journal: July/August 2016 - Volume 20 - Issue 4 - p 6–8
doi: 10.1249/FIT.0000000000000212
Departments: Health & Fitness A to Z
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Ralph La Forge, M.Sc., FNLA, CLS, is a physiologist and Diplomate of the Accreditation Council for Clinical Lipidology for which he is the immediate past president. He also is immediate past president of the Southeast Lipid Association. Ralph is a consultant to a number of health care and accountable care organizations on inaugurating systematic approaches to managing lipid disorders, and he is senior consultant to the U.S. Indian and Alaskan Health Service Division of Diabetes Treatment and Prevention. In addition, he is on the teaching faculty at the University of North Carolina Chapel Hill Complementary and Integrative Medicine.

Disclosure: The author declares no conflict of interest and does not have any financial disclosures.

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HISTORICAL PERSPECTIVE

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The Asian yoga and tai chi disciplines are at the root of most contemporary mindful exercise programs taught today. These two ancient forms integrate mind and body along with an overt sense of spirituality and grounding in nature. At the heart of all meditative practice in Asia is what Indians call yoga. Yoga is a complex system of physical and spiritual disciplines fundamental to a number of Asian religions such as Hinduism and Buddhism. For example, classical yoga, as described in the Yoga Sutra, an ancient text of yogic principles attributed to Patanjali, is composed of eight components, or limbs: moral principles, observances, posture, breath control, withdrawal of the senses, concentration, meditation, and pure contemplation (1). Here, posture refers to yogic exercises, or asanas, that originally were used to prepare for practicing breath control and meditation. The physical arm of yoga, hatha yoga, when coupled with a contemplative component, is perhaps the most practiced form of mindful exercise in the West today. Likewise, tai chi has a nearly 4,000-year heritage and is derived from qigong (also called chi kung), which describes the entire tradition of spiritual, martial, and health exercises developed in China. Qigong is the primary Chinese methodology for activating the medicine within, or the natural self-healing resource. This ancient practice combines two ideas: Qi is the vital energy of the body, and gong is the skill of working with the qi (also called chi). Tai chi, the martial art derivative of qigong, is perhaps best described as a moving meditation. Most contemporary mindful exercise programs (e.g., Nia, ChiRunning) are derived from elements in early yoga and qigong practices.

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CHARACTERIZING MINDFUL EXERCISE

Mind-body exercise programs (I actually prefer to use the term mindful exercise) have established themselves as significant players in individual and group exercise programming. In its most unvarnished form, mindful exercise is perhaps best characterized by low- to moderate-intensity physical activity performed with a meditative, consciously proprioceptive sense and with attention to breath. Mindful exercise also can be described simply as physical activity executed with a profound inward mental focus. Clearly, any form or level of physical activity can incorporate a mindful component, but less intense physical activity may provide a preferable platform for cognitive benefits. This inwardly directed attention should be focused in a nonjudgmental fashion on self versus, for example, target heart rate or actual physical performance. Self-focus may include specific internally directed attention to breathing and/or proprioception or muscle sense. For example, from the viewpoint of someone who is unfamiliar with hatha yoga, the popular cobra pose may appear to be nothing more than a back extension exercise; however, to the devout yoga practitioner, correctly engaging this pose induces a much deeper cognitive and kinesthetic experience. For many, this calming/contemplative state that is experienced may confer health benefits, precluding the need for higher-intensity exercise for those who either cannot perform, or choose not to undertake, higher-intensity traditional exercise.

There is a growing body of scientific evidence supporting various mindful exercise modalities as a significant means of improving a variety of health outcomes. Principal among those most consistently reported are blood pressure reduction, improved balance control, decreased physical pain perception, increased pulmonary function, and a reduction in anxiety and depressive symptoms (2–5).

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There is a growing body of scientific evidence supporting various mindful exercise modalities as a significant means of improving a variety of health outcomes. Principal among those most consistently reported are blood pressure reduction, improved balance control, decreased physical pain perception, increased pulmonary function, and a reduction in anxiety and depressive symptoms (2–5).

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COMMON COMPONENTS OF MIND-BODY EXERCISE PROGRAMS

For mind-body exercise to be optimally fulfilling, it requires more than merely adding a cognitive component to conventional physical activity. The criteria for what constitutes mind-body exercise continue to evolve as more definitive research is conducted and published and more programs are developed. The following criteria are recommended for mind-body exercise:

  • Meditative/contemplative. This noncompetitive, present-moment, and nonjudgmental introspective component is process centered versus strictly outcome or goal oriented.
  • Proprioceptive and kinesthetic body awareness. This generally is characterized by relatively low-level muscular activity coupled with mental focus on muscle and movement sense.
  • Breath centering or breathwork. The breath frequently is cited as the primary centering activity in mindful exercise. There are many breath-centering techniques in yoga, tai chi, and qigong exercise.
  • Anatomic alignment or proper choreographic form. Disciplining oneself to a particular movement pattern or spinal alignment is integral to many forms of mind-body exercise such as hatha yoga, Alexander Technique, Pilates, and tai chi. It also is important to note that not all mindful exercise forms use a set choreography or disciplined anatomical alignment characteristics. Examples include Nia and expressive ethnic dance exercises such as Native American spiritual dancing, which may exhibit significant freeform movement.
  • Energycentric. This component refers to the perceptive movement and flow of one's intrinsic energy, vital life force, chi, prana, or other positive energy commonly described in many classical mind-body exercise traditions.

Structured mind-body techniques can be incorporated into a host of traditional group exercise and personal training settings, although it is important to understand that this combination does not substitute for the more profound cognitive benefits of, for example, a restorative yoga or tai chi chih class.

The following are several methods whereby one or more mind-body exercise characteristics can be integrated into a personal training session:

  • Meditation and yogic-breathing exercises can be integrated with existing warm-up and cool-down exercises. For example, begin the warm-up session with a 3- to 5-minute quiet contemplation or meditation session before progressing to low- to moderate-level aerobic or flexibility exercise. One to two minutes of yogic breathing exercise also can be added here. The client can end the entire exercise session with a similar meditation component.
  • Personal trainers can incorporate a mindful component in the aerobic phase of an exercise session. This is executed optimally with low- to moderate-intensity aerobic or strength exercise (e.g., 30% to 60% of maximum effort level or aerobic capacity) in contrast to high-intensity exercise. Adding a mindful component to a flexibility exercise, low-level cycling, slow intentional muscular contractions during strength training, or walking can be quite rewarding. For example, during low-level cycling exercise (i.e., with low to moderate resistance on the pedal crank axis), clients can add a present-moment nonjudgmental focus on muscle sense while synchronizing slow abdominal breathing with every two or three pedal crank revolutions. ChiRunning and Chi Walking are excellent examples of this kind of mind-body integration process (www.chirunning.com).
  • Personal trainers can incorporate any of the select yoga poses described in the restorative or Iyengar tradition into the flexibility and strength training components of their program. For example, inserting the seated or standing spinal twist pose, child's pose, or cobra pose between resistance training exercises may increase flexibility and serve as a welcome period of relative rest and energy restoration. It is imperative that proper yogic breathing accompany these exercises.
  • The popular tree pose can be included as part of a circuit of exercises to help stimulate and improve balance control. Balance is seldom addressed by personal trainers even when working with those clients who need it most — older adults.

Personal trainers can incorporate a mindful component in the aerobic phase of an exercise session. This is executed optimally with low- to moderate-intensity aerobic or strength exercise (e.g., 30% to 60% of maximum effort level or aerobic capacity) in contrast to high-intensity exercise. Adding a mindful component to a flexibility exercise, low-level cycling, slow intentional muscular contractions during strength training, or walking can be quite rewarding.

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The tree pose (illustrated on page 7) is attained by starting with a slow exhalation and assuming a single-leg stance on the right foot while bending the left knee and placing the sole of the left foot, toes pointing down, on the inside of the right leg between the knee and groin. While inhaling, the client brings the arms overhead and joins the palms together. He or she holds this pose for three to five breaths in the beginning sessions, and six to eight breaths in later sessions. He or she then repeats the pose while standing on the opposite leg. Using a nearby table or wall for support will be helpful in early stages of training for this pose.

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FUTURE DIRECTIONS

Mind-body therapies continue to emerge as effective fitness and disease management modalities. The growing scientific support of mindful exercise strategies to help treat anxiety and depressive disorders, hypertension, cardiovascular disease, and many other chronic disease states has motivated many to adopt practice protocols. Regular and self-regulated mindful exercise may be ideal for many because of its portability and relative low-intensity nature particularly for nonambulatory patients and seniors. In the near future, the fitness and health care industry likely will see the institution of mindful exercise consensus practice guidelines and professional resources that recommend appropriate quality and quantity of mindful exercise for primary and secondary disease prevention. The alliance of traditional health promotion programming with mindful exercise interventions should further reduce health care use and the unnecessary burden of chronic and degenerative disease. Given the present mandate for implementing integrated disease prevention and disease management programs to effectively reduce health care costs and inspire self-care in our clients and patients, mindful exercise will be a helpful element.

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References

1. Bryant EF. The Yoga Sutras of Patanjali: A New Edition, Translation, and Commentary. New York (NY): North Point Press; 2009. 672 p.
2. Adhana R, Gupta R, Dvivedii J, Ahmad S. The influence of the 2:1 yogic breathing technique on essential hypertension. Indian J Physiol Pharmacol. 2013;57(1):38–44.
3. Haider T, Sharma M, Branscum P. Yoga as an alternative and complimentary therapy for cardiovascular disease: a systematic review. J Evid Based Complementary Altern Med. 2016. [Epub ahead of print].
4. Liu X, Clark J, Siskind D, et al A systematic review and meta-analysis of the effects of Qigong and Tai Chi for depressive symptoms. Complement Ther Med. 2015;23(4):516–34.
5. Ospina MB, Bond K, Karkhaneh M, et al Meditation practices for health: state of the research. Evid Rep Technol Assess (Full Rep). 2007;(155):1–263.
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Further Reading:

• La Forge R. Mind-body exercise. In: American Council on Exercise, editors. ACE Personal Trainer Manual. 5th ed. San Diego (CA): American Council on Exercise; 2014. Chapter 13.
    © 2016 American College of Sports Medicine.