Since the early 1990s, there has been a rapid growth of mind-body exercise, herein referred to as mindful exercise, in health clubs, fitness centers, and cardiovascular disease prevention and management programs. These programs frequently complement or act as an alternative to conventional exercise programs. It is important for health/fitness professionals to have some understanding, if not a limited personal experience, with one or more of these movement forms as mindful exercise programs make up as much as 30% of exercise programming in fitness centers and health clubs in the United States 14).
Although there is no universal consensus definition, mindful exercise has been recently characterized as physical exercise executed with a profound inwardly directed contemplative focus (IDEA Mind-body Fitness Committee 1997-2001). This inwardly directed attention is performed in a nonjudgmental fashion with specific attention to breathing and proprioception or "muscle sense." Perhaps the single most extolled value of mindful exercise is that it addresses a more intrapersonal quality principally because of the attention that is typically drawn to the self. Clearly, any form of physical activity can integrate this inner-attentiveness or a cognitive component; however this is the key feature and process in mindful exercise. The central objective of mindful exercise is to couple low- to moderate-level muscular activity with "nonjudgmental mindfulness." Classic mindful exercise such as yoga and Tai Chi are attentive to the present moment and are process oriented. This process contrasts with most conventional forms of exercise where there is a relative disconnect between mind and the simple kinesthesis of physical activity, that is, the mind may wander between present, past, and future. This "disconnect" does not necessarily disadvantage conventional aerobic exercise but may serve as a distraction from life stress or exertional fatigue itself.
Mindful exercise generally relies on self monitoring of perceived effort, breathing, and nonjudgmental self awareness rather than cueing entirely on an exercise leader or peer-influence, as is most often experienced in conventional group exercise classes. It can be readily executed at low to moderate exercise intensities and is adaptable to a wide range of functional capacities. For example, a contemporary adaptation of Iyengar Yoga, called Restorative Yoga, can be easily customized for nearly any age, level of fitness, body type, or chronic disease state with skillful instruction. Placing several blankets under the upper torso while in a savasana pose can provide initial support for the lower back when learning to prepare the lower back for a bridge pose (back bend) is one example of how the inclusion of props, such as blankets, can be used to prepare an older adult for a more difficult pose. From the viewpoint of someone who is unfamiliar with Hatha Yoga, the popular triangle pose (see photo below) may appear to be nothing more than a lateral side stretch exercise. However, internally, the yogi's cognition is deeply entrained on the simple kinesthesis of the pose and breath centering-nothing more and nothing less. Many will find these attributes beneficial in managing specific musculoskeletal health concerns and reduction of anxiety and stress-related symptoms, but perhaps most importantly improved self-awareness and peace of mind. The following is a brief description of several classic and contemporary forms of mindful exercise. It is important to understand that each of these forms requires hundreds of hours of personal exploration and objective feedback to attain a sufficient level of teaching skill and knowledge of that system's tradition. To enumerate and discuss the many hundreds of published original investigations particularly on yoga, Tai Chi, and Qigong exercise is beyond the intent and space constraints of this paper and is addressed more fully elsewhere (1, 2). Therefore, please consider this paper to be but a cursory and, hopefully, a helpful introduction to these ancient forms of expressive and contemplative exercise.
Essential Components of Mindful Exercise
The criteria or unitive disciplines for what constitutes mindful exercise is likely to see changes over the next few years as a more definitive taxonomy and health-related outcomes measures are established. For now, the following component criteria appear to be key prerequisites for mindful or "mind-body" exercise:
- Meditative/contemplative. A noncompetitive, present-moment, and nonjudgmental introspective component that is process-centered versus being strictly outcome or goal oriented.
- Proprioceptive awareness. Mindful exercise is characterized by low- to moderate-level muscular activity coupled with mental focus on muscle and movement sense.
- Breath-centering. The breath is frequently cited as the primary centering activity in mind-body exercise. There are many breath-centering techniques used in yoga, Tai Chi, and Qigong exercise.
- Anatomic alignment, such as spine, trunk, and pelvis, or proper physical form. Disciplining oneself to a particular movement pattern or spinal alignment holds true for many forms of mind-body exercise but particularly Hatha Yoga, Alexander technique, Pilates, and Tai Chi. It also is important to note that not all mindful exercise forms use a set sequential choreography or disciplined anatomical alignment characteristics. Exceptions would be Neuromuscular Integrative Action (NIA) and expressive ethnic dance exercise, (e.g., Native American spiritual dance that exhibits free-form movements, for example Camai, performed by Alaskan Natives [Yupik Eskimos] in Western Alaska).
- Energy-centric. Awareness of the movement and flow of one's intrinsic energy, vital life force, chi, prana, or other positive energy common to that described in many traditional mindful exercise programs.
Overview of Mindful Exercise Modalities
The origins of many contemporary mind-body exercise programs we see today lie in the Eastern disciplines of yoga and Qigong. Yoga literally means "to yoke" or "union." The "union" refers to an integration of mind, body, and spirit. When we use the word yoga here we are referring to Hatha Yoga. Hatha Yoga is the physical aspect of this discipline and includes a vast repertoire of physical postures or asanas, which are performed while sitting, standing, or lying prone or supine on the floor. Some of the more popular asanas in the West include (English names) Corpse Pose, Cobra, Triangle, Bridge, Plank, Lotus, Warrior, Downward Facing Dog, and the Sun Salutation (a sequence of 12 poses). There is a rich body of research on yoga particularly on Therapeutic Yoga, for which the reader is referred to one recently published bibliography (2).
Factors Determining the Difficulty and Intensity of Hatha Yoga Styles
The level of difficulty and physical intensity of the various styles of Hatha Yoga depend as much upon the instructor as the nature of the yoga poses and pose sequences themselves. Ashtanga or "Power Yoga" is generally considered the most difficult of the styles discussed. The princpal factors that determine the level of difficulty and overall intensity of the various styles of Hatha Yoga are listed in Table 1.
The principal challenge of nearly all styles of Hatha Yoga is to become proficient at handling increasingly greater amounts of "resistance" (i.e., complexity and degree of difficulty) in the various postures and breathing patterns while maintaining a "homeostasis" of mind and body-or the simultaneous quieting of thoughts and relaxation of body tension. The strength, flexibility, and discipline required to attain a near perfect stance, alignment, and posture can take months to many years to master. It is this physical discipline that draws many to a Hatha Yoga practice as this process can establish a template for other healthy lifestyle changes such as regular meditation practice and diet. Finally, it is paramount that yogic breathing, of which there are many techniques, be executed in synchrony with each pose (i.e., there should be no time during the asana during which the breath is held).
Yogic Breathing (Pranayama)
In the yogic and Qigong traditions, breathing functions are an intermediary between the mind and body. Breath centering itself stands as an independent method of reducing mental tension and increasing relaxation in the short-term and psychological well being in the long-term. Optimal breathing is best performed by diaphragmatically breathing (deep abdominal breathing) quietly through the nose versus the mouth. Each breath is intentionally slow and deep with an even distribution or smoothness of effort. R. Sovik (3) recently published a helpful review on yogic breathing technique. He describes optimal yogic breathing as diaphragmatic, nasal (inhalation and exhalation), deep, smooth, even, quiet, and free of pauses. Yogic breathing also has been discovered as a therapeutic modality in a number of chronic medical conditions including chronic heart failure (4).
In Hatha Yoga, yogic breathing is combined with yoga exercise in a very logical way. Whenever a yoga movement or pose expands your chest or abdomen, you want to INHALE. Conversely, when a movement contracts or compresses your chest or abdomen, you want to EXHALE (Figure).
Hatha Yoga Styles
There are many different styles of Hatha Yoga, depending upon their historical derivation, level of mindfulness, asana form, and the depth of integrated breath work. The following are several methods of Hatha Yoga that are commonly practiced throughout the United States and Europe today:
- Iyengar Yoga. Iyengar Yoga was originally developed by B. K. S. Iyengar, who systematized more than 200 classical asanas (poses) from very simple to very difficult. Much emphasis is placed on precise anatomic alignment, which over the years has refined the therapeutic aspects of yoga. Iyengar places much emphasis on breathing (pranayama). The use of props (e.g., bolsters, blankets, and blocks) to assist with attaining appropriate spinal alignment is one of the characteristics of Iyengar classes. Perhaps the most authoritative and detailed illustrated texts on Iyengar Yoga is B.K.S. Iyengar's Light on Yoga (5).
- Restorative Yoga. This style of Hatha Yoga is a derivative of the Iyengar Yoga tradition and is perhaps most appropriate for those who are just embarking on a yoga program because of the use of props (e.g., blankets, pillows, lumbar and neck rolls, and bolsters) and the elementary but progressive nature of the poses. Judith Lasater and others have introduced this form of Iyengar Yoga. Restorative Yoga is easier and more relaxing for those who are nonambulatory or relatively weak or fatigued, or for those who practice yoga during peak stressful periods in life. Some of the more popular poses in this form are legs-up-the-wall, supported half-dog, chair forward bend, and half-wall hang (6).
- Ashtanga Yoga. This is the ancient system of Hatha Yoga currently taught by Pattabhi Jois in Mysore, India. This method synchronizes a progressive series of postures with a specific breathing method (ujjayi pranayama). The asanas in Ashtanga Yoga are sequenced in groups of poses ranging from moderate to very difficult. The sequence pace and pose difficulty is what often characterizes Ashtanga as "Power Yoga." Ashtanga places equal emphasis on strength, flexibility, and mental and physical stamina.
- Anusara Yoga. Founded by John Friend of Shenandoah Texas, this form of Hatha Yoga closely resembles Iyengar and stresses three focus points: attitude, alignment, and action. Participants are taught to be cognizant of their "key power center" or focal point-the point during an asana at which most of the body weight or musculoskeletal force is placed.
- Viniyoga. This is a softer and more individualized form of Hatha Yoga. One key feature is the careful integration of the flow of breath with movement of the spine. Emphasis is placed upon breathing (pranayama) and coordination of breath and movement. Viniyoga also is known for therapeutic application of the classical asanas or poses. Viniyoga is usually taught on a one-on-one basis. Gary Kraftsow's text (7) is a contemporary descriptive work on Viniyoga.
- Kripalu Yoga. A three-level style of Hatha Yoga customized to the needs of Western students. The first stage teaches the basic mechanics of the postures including body alignment and coordination of breath and movement. Stage two includes a prolonged holding of the poses as the student learns to practice a disciplined mental concentration. Stage three involves a spontaneous moving meditation set to the individual's internal awareness and energy. The Kripalu method of teaching and practicing yoga blends the physical postures of Hatha Yoga with the contemplative meditation of Raja Yoga.
- Integral Yoga. This yoga form gently stretches, strengthens, and calms the body and mind. Includes comfortable postures, deep relaxation, and breathing practices. This form of yoga places significant emphasis upon diet and is used in Dr. Dean Ornish's heart disease reversal programs around the United States (8).
- Bikram Yoga. Bikram Yoga is a vigorous 90-minute, 26-pose series designed to warm and stretch muscles, ligaments, and tendons in a particular sequence. Since most Bikram studios are heated from 90-105°, the participant needs to have a large towel, a washcloth (sometimes two), and a water bottle for class.
- Kundalini Yoga. Also called the yoga of awareness, Kundalini Yoga's principal purpose is to awaken the serpent power (kundalini or coiled-up energy) with postures, breath control, chanting, and meditation. Originated by Yogi Bhajan, each class usually entails spine and flexibility warm-up, specific asana sequences commensurate with one's "coiled up energy," and relaxation. Each asana is symbolic of a life habit and emotion with a specific associated breath.
- Sivananda Yoga. A style of Classic Yoga with traditional poses, breathing exercises, and relaxation. This style teaches 12 postures comprising the Sun Salutation sequence and can be readily adapted to beginners or those who have low functional capacities. The Sivananda Yoga Vedanta Center of New York has trained more than 15,000 yoga teachers worldwide and is widely respected for teaching authentic Hatha Yoga.
Perhaps the simplest (and most practiced worldwide) form of mindful exercise is Qigong exercise. Qigong is a system of self-healing exercise and meditation that includes healing postures, movement, self massage, breath work, and meditation. Qigong exercise, otherwise known as Chinese Health Exercise, has a heritage dating back more than 3,000 years. Qigong movements are executed at very low energy expenditure levels, usually between 2-4 METs and include standing, sitting, and supine positions. For this reason Qigong exercise is nearly perfectly suited for seniors and those with disabilities. There are many Qigong exercise styles, and all are based upon balance, relaxation, breathing, and good posture. Some are named after animals whose movements they imitate, such as Dragon, Swan, Crane, Snake, Wild Goose, and Animal Frolics styles. Qigong culture holds that inhaling brings positive qi into your body and is usually accompanied with an "opening" movement (e.g., arms opening away from the body) while exhaling releases the negative qi and accompanies a "closing" movement (e.g., arms back to the body). Taiji Qigong is ideal as a preparation for higher intensity conditioning exercise or as a cool-down. For those interested in reviewing a large body of Qigong and Tai Chi research, the Qigong database is the most assessable and complete research repositories anywhere with more than 3,500 research abstracts and reviews (9).
Tai Chi (shorthand for Tai Chi Chuan or Taijiquan) is one form of the more ancient practice of Qigong (Chinese health exercise). Tai Chi Chuan is a complex martial arts choreography of 108 flowing graceful movements that can be practiced for health, meditation, and self defense. There is abundant research on Tai Chi especially with reference to health improvement. For example, over the last decade there has been a number of controlled trials demonstrating improved balance, reduction in falls, and increased functionality in seniors (10, 11).
There are numerous forms or styles of Tai Chi Chuan, for example, the original Chen or the relatively more recent Yang, Wu, and Chang styles. Each form emphasizes a particular aspect, such as breathing, generating power, or relaxation. Some styles have a short form that may be more adaptable to those with disabilities. In Tai Chi, students are taught to allow the practice to evolve into a free-flow exercise such that the movements and breathing become one unified energy (qi) flow. Tai Chi Chih, developed by American Justin Stone, is a simpler form of Tai Chi Chuan and consists of a series of 20 movements and one ending pose. Qigong exercise (Chinese health exercise) involves even a simpler set of movements than its martial arts relative Tai Chi.
- Original Chen form. The original Chen style (old form) is thought to be the template form from which the more recent Wu, Yang, and Sung forms descended.
- Yang Style. Originated by Yang Luchan in the 1800s, the Yang form is the most widely practiced form in the West today. The original Yang form consists of 108 movements (Yang Long Form); however, the Yang 24-Short Form is a popular modification practiced today.
- Chang Style. A relatively new style of Tai Chi developed by Chang Tung-Sheng in the 1930s. Chang style consists of more than 100 movements and is based upon modifications to the Yang Long Form.
- Wu Style. This style of Tai Chi was developed by Master Wu Chien-Chuan and is second in popularity only to Yang Style Tai Chi. Wu style is an easier form of Tai Chi with smaller steps and smaller circular forms, and its movements involve less twisting and impose less stress on the legs and knees. The condensed form of Wu style includes 36 postures.
- Sun Style. Developed by Sun Lu-Tang in the late 1800s, Sun style Tai Chi combines elements of Wu and Yang style Tai Chi.
Contemporary Mindful Exercise Forms
Since the early 1980s, numerous mindful exercise program derivatives have evolved from the classic traditions of Qigong, Tai Chi, and yoga. Some of these contemporary forms are NIA, Chi Ball, Meditation Walking, E-Motion, Brain Gym, Yogarobics, Yogilates, Chi Running, Aqua Tai Chi, Yo Chi, Flow Motion, mind-body circuit exercise, and many ethnic dance routines. The Asian martial arts (e.g., Aikido, Karate, Tae Kwon Do, Kempo, and Judo) also share many of the characteristics of early classic forms such as Tai Chi. Pilates, Alexander, Feldenkrais, and various modern Hatha Yoga styles have likewise matured as respected mindful exercise and rehabilitative methods as their techniques have been largely standardized over the last three decades.
The Pilates method was developed by German immigrant J. H. Pilates in the early 20th century. Pilates is an extremely orderly system of slow, controlled, distinct movements that clearly demand a profound internal cognitive focus. This method is essentially divided into two modalities, floor or mat work and the work on the resistance equipment that Pilates developed, called the Universal Reformer. Mat work is taught in either a group or private setting, whereas work on the equipment is generally learned one-on-one or in small groups. Pilates is essentially a form of movement re-education in which the student learns to overcome faulty compensatory movement patterns. These inefficient movement patterns are broken down into components by using springs (a component of specialized equipment called a Reformer) and changing the body's orientation to gravity. Pilates exercises are designed to facilitate more efficient movement behavior by allowing the student to be in a position that minimizes undesirable muscle activity that can cause early fatigue and lead to injury. Performing Pilates exercise is more about how to move, not how fast, how far, or how much. Pilates equipment, for example, the Reformer, is constructed in a manner that can accommodate many human anatomic variations and can be adjusted such that similar properties of movement sequencing can be applied to a variety of body types and limb/torso lengths. Pilates is advantageous for those who desire individualized low-impact exercise to improve posture, flexibility, and functionality. Other benefits of a Pilates training program are increased muscular strength and flexibility particularly of the torso and abdominal regions, an improved balance of strength and flexibility, and the potential for injury prevention. One recent observational prospective study demonstrated measurable increases in lower back and hamstring flexibility after six months of training (12).
The Neuromuscular Integrative Action (NIA) technique was created by Debbie and Carlos Rosas of Portland, Oregon in 1983 and represents a composite of both Eastern and Western mind-body exercise influence and has grown in popularity in many health clubs and fitness centers throughout the United States. NIA classes blend movements and concepts from a diversity of cultures, including Tai Chi, yoga, martial arts, and ethnic and modern dance. In this sense, NIA is a near "pure" mindful exercise modality because of its composite make-up of classic and contemporary forms. The NIA technique is based upon a process termed "the body's way" and incorporates 9 movement energies, 13 primary principles, and 52 basic moves (13). Unlike other mindful exercise programs, NIA also includes a moderate-level aerobic component to address cardiorespiratory endurance. The aerobic segment is designed to foster creativity and spontaneity rather than strict adherence to standard group movement patterns. Participants are taught to move with self expression and couple movement tempo with their emotion.
The Alexander technique, as established by Frederick Alexander in the late 19th century, is a method that teaches the transformation of neuromuscular habits by helping an individual to focus upon sensory experiences. It corrects unconscious habits of posture and movement that may be precursors to injuries. This method is useful for individuals with disc trouble, sciatica, low back pain, whiplash injury, shoulder-arm pain, neck pain, and arthritis and also for athletes who wish to move with more ease and greater coordination. The Alexander technique is taught one-on-one or in small groups by an Alexander-certified teacher.
The Feldenkrais method was developed by the Russian Moshe Feldenkrais in 1904 and consists of two interrelated, somatically based educational methods. The first method, Awareness Through Movement (ATM), is a verbally directed technique designed for group work. The second method, Functional Integration, is a nonverbal manual contact technique designed for people desiring or requiring more individualized attention. The ATM method incorporates active movements, imagery, and other forms of directed attention. These are gentle, nonstrenuous exercises designed to re-educate the nervous system with the emphasis placed upon learning how to move properly from the individual's own kinesthetic feedback. Sessions are taught with the practitioner gently touching or moving the student in a variety of ways to facilitate awareness and vitality.
Mindful exercise creates relaxation from within by relaxing the muscles, slowing the breathing, and most importantly, calming the mind. There is scientific evidence that hypertension, insulin resistance, anxiety disorders, pain, cardiovascular disease, and depression all favorably respond to regular participation in mindful exercise such as Tai Chi, Qigong, and Hatha Yoga (Table 2) (1, 2). The core benefits that these programs offer include increased balance, strength, and flexibility as well as an immediate source of relaxation and mental quiescence. Regular and self regulated mindful exercise also may be ideal for seniors and those with stable chronic disease because of its portability and relative low-intensity nature. Arguably, there are many benefits extolled by mindful exercise organizations and practitioners that have yet to be confirmed by controlled research, for instance, objective measures of muscle morphology changes, improved function of select organs, and reversal of chronic disease. As research interest and funding increase, so will the number of more meaningful published outcome trials. Two particularly worthy research issues are discriminating benefit differences between styles of Hatha Yoga therapy and objective muscular fitness and functional outcomes with Pilates training. Finally, consensus teaching and performance guidelines on mature forms of mindful exercise, particularly Hatha Yoga, are continuing to evolve and should soon be included in respected exercise science publications that recommend the appropriate quality and quantity of exercise for primary and secondary prevention programs.
Condensed Version and Bottom Line
Mindful exercise can complement and can serve as an alternative to conventional exercise programming provided the participant understands the purpose and nature of the mindful exercise modality. The purpose of this article is to introduce health/fitness professionals to the scope and purpose of mind-body (mindful) exercise and to illustrate the tenets of several classic and contemporary forms. Competently taught mind-body exercise programs have become well established in health/fitness centers throughout North America.
Mindful Exercise Teacher Training Resources
There are many teacher training and certification programs for prospective Tai Chi, Qigong, NIA, Pilates, and particularly yoga teachers. Unlike many exercise instructor certification programs, such as ACSM, ACE, and AFAA, most of these programs do not follow a standardized set of practice guidelines that cover a core curriculum such as exercise, pre-exercise assessment, program implementation, and exercise safety. This does not mean that there are not many well planned and professionally conducted yoga, Tai Chi, and Pilates teacher training programs; however, historically there have been no central practice guidelines or regulations governing core material in such programs. Perhaps, in the case of some of the more classic forms (e.g., yoga and Tai Chi), this is because many of these steadfastly adhere to traditional ethnic heritages and teachings or sutras in an effort to maintain a level of purity and respect for the respective tradition. For yoga, one promising new professional body establishing teacher standards is the Yoga Alliance. This organization maintains a national registry of yoga teachers and schools who meet the Alliance's recommended educational standards and strongly encourages the inclusion of core competencies. The Pilates Method Alliance, a non-profit organization dedicated to the teachings of Joseph and Clara Pilates, also is dedicated to establishing certification and continuing education standards for Pilates professionals.
Select Yoga and Tai Chi Education and Training Resources
Yoga Alliance: www.yogaalliance.org
, Ph: 877-964-2255.
Kripalu Center for Yoga and Health. Ph: 800-741-7353.
YogaFit International. [email protected]
, Ph: 888-786-3111.
Yoga for The West Teacher Training Course by Mara Carrico. Ph: 760-942-4244.
Integrative Yoga Therapy. www.cruzio.com
, Ph: 800-750-9642.
Qigong Institute. www.qigonginstitute.com
, Ph: 415-323-1221.
National Qigong Association USA. www.nqa.org
, Ph: 218-365-6330.
Justin Stone's Tai Chi
NIA Teacher Training Programs. http://www.nia-nia.com/Company/becomeateacher.html/
, Ph: 1-800-762-5762.
Pilates Method Alliance. www.pilatesmethodalliance.org
, Ph: 866-573-4945.
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Cohen, K. S. The Way of Qigong
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Dong, P., and A. Esser. Chi Gong: The Ancient Chinese Way to Health
. New York: Marlowe & Co., 1999.
Huang, A. Complete Tai-Chi
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Miller, B. S. Yoga: Discipline of Freedom
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Pilates, J., W. Miller, and J. Robbins. A Pilates Primer: the Millennium Edition
. Presentation Dynamics, Inc., 2000.
Stewart, K. Pilates for Beginners
. HarperResource, 2001.
Tse, M. Qigong for Health and Vitality
. New York: St. Martin's Griffin, 1995.
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