Hatha yoga is an increasingly popular form of physical activity in the United States (4,18,21,40) and may be one of the world’s fastest growing health and fitness activities (4). Yoga originated in ancient India where its practice was intended to help “redirect a person’s search for happiness from external sources to internal ones” and eventually result in life fulfillment, wholeness, and enlightenment (8,29). Hatha yoga is one path that traditionally integrates the physical practice of asanas (holding poses or postures), pranayama (breathing control/exercise), bandhas (muscular contractions), mudras (seals and gestures), kriyas (internal cleansing techniques), and meditation (contemplative thought), along with a spiritually based philosophical framework (e.g., which includes nonviolence, truthfulness, and nonstealing). Since the 1960s and 1970s, Hatha yoga has undergone various adaptations in the United States and has become a practice believed to promote physical fitness, stress reduction, and relaxation (4,8,29). Yoga is offered in a majority of US health clubs (8) as well as a growing number of yoga studios and private homes. Classes are typically 60 to 90 min in duration and involve flowing through a series of asanas and pranayama. Depending on the style, studio, and/or teacher, asanas are held standing, seated, or supine for various amounts of time and may involve balance and inversion poses with focus on proper form, alignment, and breathing. The rhythmic flow through a specific sequence of 12 asanas with controlled breath, termed Surya Namaskar (sun salutations), is often incorporated into many styles/classes and is thought to promote cardiorespiratory fitness (23). Classes typically end in a supine posture called Savasana (corpse pose), and many incorporate meditation. Specific styles of yoga such as Bikram (4,7) and hot power yoga (4) have also separated from traditional Hatha practice. Both styles—although distinctly different—incorporate set sequences of basic Hatha poses but are conducted in a hot and humidified room. Practice in this environment is believed to loosen joints, muscles, and tendons and help students push themselves, providing a gratifying sense of progress (4). Yoga has even emerged as a component of the new-generation active computer games (13,22) with Wii Fit plus software containing at least 18 modes of yoga (22).
Recent data suggest that as many as 20.4 million Americans (8.4% of the US population) practiced yoga in 2012, up from 15.8 million in the previous 2008 survey, with an additional 44.4% expressing interest in trying yoga (40). With the increasing popularity of Hatha yoga, it is important to understand the energy cost and intensity of yoga and its various asanas and pranayamas within the context of the public health and exercise prescription guidelines recommended by the American College of Sports Medicine (ACSM) (2,10,12,16) and the American Heart Association (AHA) (16). To promote and maintain health and reduce disease risk, the ACSM/AHA guidelines encourage 30 min of moderate-intensity aerobic physical activity 5 d·wk−1 or vigorous-intensity aerobic activity for a minimum of 20 min 3 d·wk−1. The public health guidelines define absolute intensity in terms of METs (16) rather than estimates of relative intensity that are more commonly used for individual exercise prescriptions. These typically include percentages of maximal HR (%HRmax), HR reserve (%HRR), maximal oxygen uptake (%V˙O2max), or maximal oxygen uptake reserve (%V˙O2R) (see Table 1) (12). METs are useful for expressing the energy cost and intensity of physical activity as a ratio to metabolic rate at rest, standardized as 3.5 mL·kg−1·min−1 in a manner comparable among persons of different weights and physical fitness. Moderate- and vigorous-intensity physical activities are defined as intensities between 3 and 6 METs and greater than 6 METs, respectively (16). Current physical activity guidelines also emphasize that combinations of moderate- and vigorous-intensity activity are likely to have similar health benefits as continuous activity and can be combined in shorter bouts of at least 10 min throughout the day to meet guidelines. The goal is to achieve 450 to 750 MET·min·wk−1 (i.e., METs × daily min accumulated × number of times per week) (16).
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TABLE 1: Classification of absolute and relative exercise intensity.
The purpose of this article is to twofold: 1) to provide a systematic review and evaluation of the literature concerning energy cost and intensity of yoga asanas and yoga practice according to the current ACSM and AHA guidelines (12,16) and 2) to evaluate the quality of published studies measuring the energy cost of yoga asanas, pranayama, and complete practice via indirect calorimetery. Although a small handful of studies have measured the metabolic cost of individual yoga asanas and full yoga sessions, a summary of the energy cost and intensity of yoga is not currently available for yoga as it is for other sports (1). This information may prove useful to the exercise, nutrition, and medical professionals prescribing yoga as a fitness activity or recommending yoga practice for weight loss and/or weight maintenance (10). It may also be useful for yoga teachers and practitioners.
METHODS
The English-speaking literature was surveyed via PubMed and cross checked with the Web of Science using the general terms “yoga” and “energy expenditure” with no date limitations. To be included, articles had to use indirect calorimetry to calculate energy expenditure from measures of oxygen uptake and carbon dioxide production. Key variables of interest, including absolute and relative oxygen uptake, energy expenditure, MET values, HR, respiratory rate, and RPE, were evaluated and summarized from each identified article, and the references were scanned for additional manuscripts not identified in the initial literature search. Energy expenditure, METs, and relative HR (i.e., as a percentage of actual or estimated max) were calculated from available data if values were not reported by the authors using an assumed 5 kcal·L−1 of O2 consumed, a MET value of 3.5 mL·kg−1·min−1, and an estimated maximal HR of 220 minus average age. The names of poses are listed in Sanskrit with the common English translation listed in parentheses or defined in figure legends.
The quality of metabolic data collected by indirect calorimetry was evaluated by comparing methodology with commonly accepted standard procedures, which included the following: a) the collection of expired air into a Douglas bag, meteorological balloon, gasometer, or metabolic cart and the analysis of gas content and volume using gas analyzers, calibrated against standard gases, and a gasometer or pneumotach, calibrated with a known volume of air; b) the documentation of ambient environment, including temperature, relative humidity, and barometric pressure for the adjustment of gas volume; c) the control of time of day of measurement; and d) the control of subjects recent food and fluid intake, vigorous exercise, and other factors such as sleep, medications, alcohol, and tobacco that could alter energy expenditure. Because the various apparatuses may restrict or interfere with the practice of holding yoga asanas, attention was also placed on the apparatus used to collect expired air (e.g., mouthpiece and nose clips, face mask, and canopy hood), unless gases were collected within a room indirect calorimeter. Finally, documentation was made as to whether the yoga asanas were held to assure steady state of O2 uptake or whether the asanas were performed as a continuous flow. The commonly used standard during testing of moderate to more vigorous exercise is to have a participant exercise at a given intensity for at least 4 min to ensure steady state and analyze only the last 1 to 2 min of data.
RESULTS
Seventeen articles were initially identified using “yoga” and “energy expenditure”; 13 articles used indirect calorimetry to evaluate the energy cost of various yoga asanas or yoga practice, and 4 articles were not relevant. Additional five articles were identified from the reference list of the 13 relevant articles; however, one was published only in abstract form with insufficient data for evaluation (5). The publication dates ranged from 1962 to 2015. Articles included yoga asanas practiced in traditional Indian centers (3,23,30,31,33,34), US and European health clubs (6,7,14), Bikram-style centers (26), and as part of active video games (Wii Fit Plus) (13,22).
Indirect calorimetry methodology
Table 2 summarizes the indirect calorimetry equipment, procedures, and subject control used and/or reported compared with standard methodology. As noted in the table, less than half of the studies reported calibrating the metabolic cart (i.e., gas analyzers and pneumotach) before testing. Most did not report time of day of measurement or whether participants were asked to fast and/or follow a controlled run in diet before testing. Even fewer controlled for fluid intake, sleep, or menstrual cycle phase in females, all of which could affect energy expenditure and/or HR response during yoga. Most used commercially available metabolic carts with gases collected using either a mouthpiece and nose clips (26,32) or a face mask (13,23,30,31,33). Several studies, however, failed to report such detail. Two studies (14,22) measured energy expenditure in a full-room metabolic (respiratory) chamber, which allowed for free movement during yoga practice, and one used a canopy system (ventilated hood) during pranayama (supine breathing) only (38). The test–retest reliability of the energy cost and METs of yoga practice was reported only using the full-room calorimeter (14) and was found to be sufficiently consistent (ICC 0.97) (14).
TABLE 2: Indirect calorimetry and calibration (Cal) procedures and control of environmental (Env) and participant factors, timing, and subjects’ diet, physical activity, and other factors before testing.
Energy cost and METs of yoga practice
As summarized in Table 3 and Figure 1, the MET value of yoga practice, including exclusive movement through Surya Namaskar (Sun Salutations Flow), ranged from 2.0 METs during a Wii Yoga session (13) to more than 6 METs with the exclusive practice of Surya Namaskar in experienced practitioners (23). Of the studies included in Figure 1, five evaluated the energy cost of movement through various asanas (some including Surya Namaskar) that may be typical of a yoga practice or yoga class (7,9,14,26,33). In three of these studies, yoga participants followed a sequence set by video- or audiotaped recordings, which included a 56-min commercially available beginner Ashtanga yoga DVD (14); a 30-min videotaped, instructor-choreographed Hatha yoga routine (7); or a 90-min audio recorded Bikram session (26), which systematically transitioned through Bikrams 26 static asanas. In the other two studies, yoga participants flowed through a set sequence of static postures at a dictated pace. For example, Ray et al. (33) had participants hold seated Hatha postures for 1 to 3 min for a total of 24 min with rest in the form of Savasana (corpse pose) between postures. Dicarlo et al. (9) had participants move through 12 Hatha standing poses performed twice per side for 40 s with 10-s jump transitions into and out of tadasana (mountain pose) between poses. As shown in Figure 1, a MET value of greater than three was achieved by the standing Hatha flow with jump transitions (9) and flow through Surya Namaskar (sun salutations) in three out of the four studies (7,23,34). Flow through Surya Namaskar in experienced practitioners achieved METs in the aerobically intense range (23). The Bikram yoga sequence (26) did not result in a greater energy cost or MET intensity compared with traditional yoga in a thermal-neutral environment. MET values for yoga practice averaged 3.3 ± 1.6 METs for all 10 studies and 2.9 ± 0.8 METs when the study of Mody (23), which appeared to be a high outlier, was omitted.
TABLE 3: Summary of studies evaluating energy cost and/or intensity of yoga including yoga asanas, pranayamas, and full practice sessions.
FIGURE 1: Average METs from all participants for full yoga sessions, including exclusive devotion to flow through Surya Namaskar (Sun Salutations) with error bars representing the standard deviation of the mean. Bars are without error if only mean values were reported in the original study or if METs were calculated by the current study author from published V˙O
2 and body weight data. The average MET values for yoga practice were 3.3 ± 1.6 METs for all 10 studies and 2.9 ± 0.8 METs when the study of Mody (
23) was omitted.
Energy cost and METs of individual yoga asanas
Eight studies (3,6,26,30–33,38) evaluated the metabolic cost of various yoga asanas held in traditional Hatha or Bikram yoga (which is based off Hatha asanas). The energy cost and METs of all asanas are summarized in Table 2 and Figure 2. As previously noted, very few asanas were of the intensity to produce a MET value greater than three except Dandayamana-Janushirasana (standing head to knee) (26), Dandayamana-Dhanurasana (standing bow), Trikanasana (triangle) (26), and Tuladandasana (balancing stick) (26) during Bikram yoga. Standing asanas (9,26), for the most part, produced slightly higher average MET values than seated poses (33), as did backward bending poses compared with forward bending postures (i.e., Dhanurasana vs Paschimottanasana or seated wheel compared with forward bend) (3,33). The average METs of supine poses (i.e., Savasana or corpse pose) were comparable with rest (MET value = 1.0 (3,30,31).
FIGURE 2: Average METs from all participants for asanas with error bars representing the standard deviation of the mean. Bars are without error if only mean values were reported in the original study or if METs were calculated by the current study author from published V˙O
2 and body weight data. The study reference is shown in parentheses. Adho Mukha Svasana, down dog; Anjaneyasana, crescent lunge; Ardha Chandrasana, half moon; Ardha Matsyendrasana, half lord or half spinal twist; Bhujangasana, cobra; Dandayamana-Janushirasana, standing head to knee; Dandayamana-Dhanurasana, standing bow; Dhanurasana, wheel/seated bow; Mandukasana, frog; Maha Matsyendrasana, wise man; Matsyasana, fish pose; Paschiimottanasana, seated forward bend/fold; Poorna Salabhasana, full locust; Sarvangasana, shoulder stand; Siddhasana (also called Ardha Pashimottanasana), half clip/half forward fold; Sirsasana, head stand; Trikanasana, triangle; Tuladandasana, balancing stick; Utkatasana, chair; Virabhadrasana I, warrior I; Virasana, hero pose; Virksasanan, tree pose. Note the reference of Raj (
31) illustrates the standing pose Anjaneyasana in the methods but refers to the pose as Siddhasana (seated hero pose). The pose shown in the figure Anjaneyasana was used in this figure summary because the MET value aligns better with Anjaneyasana rather than Siddhasana.
Inversion poses including Sirsasana (head stand) did not drastically increase metabolic rate higher than the range of 1.7 to 2.5 METs (6,32). No published studies, however, measured the metabolic cost of some of the more difficult inversions/arm balancing poses, including Bakasana (crow/crane), Eka Pāda Gālavāsana (flying pigeon), and Adho Mukha Vr˙ks˙āsana (hand stand), which produced MET values >3 (Larson-Meyer, unpublished data) in the author’s laboratory.
Cardiorespiratory intensity of yoga
The percentage of actual or estimated HRmax and V˙O2max elicited by yoga practice and/or individual asanas is shown in Table 3 for all studies that provided HR data (6,7,9,13,14,23,26,33,34) and/or measured V˙O2max (7,9,33). The intensity of typical yoga practice was highly variable among studies ranging from 49% (14) to 71% (9) of actual or estimated HRmax and from 12 to 40%V˙O2max. More extreme ranges in HR were found between Wii yoga (40%HRmax) (13) and both Surya Namaskar (80%HRmax) (23) and Bikram yoga (51–90%HRmax) (26). The interpretation of HRmax appears to vary according to asanas and room temperature. V˙O2max estimates are complicated by the aerobic fitness and sex of yoga participants, which ranged from an average of 33 to 35 mL·kg−1·min−1 (7,9) to 42 mL·kg−1·min−1 (6) in female practitioners and 47 m·kg−1·min−1 in male participants (9).
Metabolic cost of yoga relative to walking
In addition to evaluating the energy cost and intensity of yoga, four studies simultaneously compared metabolic cost of yoga practice with that of walking at 2.0 (14), 2.9 (26), 3.0 (14), 3.5 (7), and 4.0 mph (9). As stated in the ACSM guidelines, an adult walking at 3 mph on a flat, hard surface is expected to expend approximately 3.3 METs (16). The METs and intensity as percentage of HRmax or V˙O2max if available are summarized in Table 3. In general, walking at 3 mph produced a similar MET response compared with yoga (14), whereas walking at a faster velocity had a higher metabolic cost (7,9).
RPE
Only one study (9) reported the RPE or effort during yoga practice. The RPE according to the Borg scale, which ranges from a value of 6 at rest to 20 at maximal effort, was 14.8 ± 1.8 METs for the aforementioned practice of standing Hatha asanas. This was significantly higher than the average RPE of 12.5 ± 1.5 for treadmill walking at 4 mph for the same subjects, despite the higher MET values elicited for walking (5.4 METs) versus yoga practice (4.1 METs).
Energy cost of pranayama
Five studies (22,26,33,36,38) evaluated the metabolic cost of pranayamas or the controlled and specific breathing patterns/movements commonly practiced in yoga using a ventilated hood (38), a cart with face mask or mouthpiece (26,33,36), or a full-room calorimeter (22). The metabolic cost of pranayamas is summarized in Figure 3. The MET values of the majority of pranayamas were slightly above rest (MET = 1.0), averaging 1.3 ± 0.3 except Yoga Mudra, Kaki Mudra, high-frequency breathing, and standing deep breathing which had METs just higher than 1.5. The metabolic cost of kapalbhati breathing was also slightly higher, but the MET value varied between studies (33,38). Pranayama did not elicit a significant change in HR response in the one study that simultaneously evaluated HR (26), but some such as kapalbhati did elevate ventilation above restful breath (33). High-frequency yogic breathing was found to increase energy expenditure from carbohydrate whereas breath awareness decreased energy expenditure from fat compared with rest, but the RER unfortunately was not reported.
FIGURE 3: Data represent the average of METs from all participants for pranayama (breathing exercises) with error bars representing the standard deviation of the mean. The average MET for yoga pranayama was 1.3 ± 0.3 METs. Bhastrika, bellows breath; Bhramari Pranayama, humming bee breath; Kaki Mudra, crow’s beak breath; kapalbhati, breath of fire; Nadi Sodhana, alternate nose breathing; Sukhasana, easy breathing; Yoga Mudra, relaxed breathing while seated cross-legged with fingers holding a yoga seal.
DISCUSSION
This work is the first to comprehensively review the published literature evaluating the energy cost and intensity of yoga practice, including individual asanas (poses/postures) and pranayamas (breathing exercises). On the basis of the ACSM and the AHA classification systems (2,10,12,16), the intensity of yoga asanas and of full yoga practice ranged from light (less than 3 METs) to moderate (3–6 METs) to vigorous aerobic (>6 METs) with the majority classified as light intensity. The asanas and sequences of asanas that elicited MET intensities in the moderate-intensity aerobic range included Surya Namaskar (sun salutations) and specific standing and balancing postures, including Tuladandasana (balancing stick) and Dandayamana-Dhanurasana (standing bow). This highlights that yoga is not typically practiced at an intensity that meets the ACSM/AHA recommendations for moderate-intensity aerobic exercise (12,16), and it is on average less aerobically intense than brisk walking. In accordance with the guidelines, however, it further highlights that the practice of sequences of asanas with MET intensities higher than 3 METs (i.e., for ~10 min or longer) can be accumulated throughout the day and count toward daily (or weekly) recommendations for moderate- to vigorous-intensity aerobic activity (16).
Energy cost and intensity of yoga practice
Despite a general classification as a light-intensity exercise modality, the findings from this systematic review suggest that the energy cost and MET intensity of a yoga session can be altered according to the asanas practiced and the velocity of flow between asanas (i.e., jump vs slow controlled transitions). Devotion of significant time to Surya Namaskar (7,23,34) and the inclusion of standing and balancing poses that involve isometric contractions with jump transitions between asanas (9) would be expected to increase overall energy cost and intensity of a yoga session (23). Alternatively, the inclusion of more seated versus standing poses with a slower flow through asanas would be expected to decrease energy cost and intensity. Quite surprisingly, this review did not find that environmental (or room) temperature had much effect on energy cost. Despite purported claims that a Bikram yoga session expends up to 1000 kcal in 90 min, the MET values of Bikram yoga (26), performed in hot room with 40% relative humidity, were within the same range as yoga practiced at room temperature. It could be argued, however, that differences might be found if the same practitioners had performed the same set of asanas in both a hot and more ambient environment. Bikram for example does not incorporate Surya Namaskar or flow transitions but instead transitions from static asana to static asana, which may require less energy than other styles with continuous flow through Surya Namaskar and other asanas.
The variability of MET intensities for Surya Namaskar (sun salutations), which ranged from 2.9 METs (light intensity) (14) to 7.4 METs (vigorous intensity), is intriguing. Flow through this specific sequence of 12 asanas, which is performed rhythmically with controlled breath, involves the majority of joints and muscles and both static stretching and dynamic muscular exercise components (34). The sequence is said to be taught to Indian children at young age and is believed to promote cardiorespiratory fitness (23). Interestingly, higher MET intensities (7.4 METs) were observed by Mody (23), who studied five Indian men and women who had trained in Surya Namaskar for at least 2 yr (23). Four rounds of Surya Namaskar were performed at a pace of 3 min per round. Although a sufficient detail on sequence execution was not described, to achieve such high MET intensities, the experienced practitioners most likely incorporated rapid stepping (or jumping) between asanas and an upward and/or downward push-up in Uttihita Chaturanga Dandasana, i.e., flow from plank pose to Bujangasana (cobra pose) and back to plank before moving into Adho Mukha Svasana (down dog). In agreement, a MET intensity of 6.4 was achieved in the author’s laboratory using Mody’s description of Surya Namaskar, transition jumps, and full pushups (Larson-Meyer, unpublished data). By contrast, MET intensities in the moderate-intensity range were observed by both Sinha et al. (34) and Clay et al. (7) in 21 newly trained male practitioners (recently completing three-months of intense training) and 26 semiexperienced female practitioners (minimum of one month of yoga attendance), respectively. The lower MET intensities of Higgins et al. (14) were observed in 18 woman and 2 men who performed 28 min of Surya Namaskar as part of a 56-min beginning-level Ashtanga session. Unfortunately, sufficient information on the Surya Namaskar flow was also not provided (7,14,34), but illustrations in the manuscripts of Sinha et al. (34) matched that of Mody (23), suggesting that the most common variation (Sun salutations A) was used in both studies. Taken together, these findings highlight that Surya Namaskar can be practiced in such a way to achieve an aerobically intense effort but also slowed to result in a light- to moderate-intensity effort.
Influence of practitioner experience
It is not yet established whether practitioner experience affects the metabolic cost of yoga practice, as it does with other types of exercise (1). One could argue on one hand that with consistent practice, yoga participants would learn to more fully express a pose that would in turn result in engagement of more muscle fibers/muscle groups, more forceful contractions of engaged muscles, and deeper movement into each pose. Full expression of many asanas, for example, requires near-maximal contraction of several muscle groups, including the abdominals and back, and an increased range of motion to lift higher or sink deeper into each asana. One could also argue on the other hand that experienced practitioners may have increased flexibility, which could result in reduced passive torque in muscle tissue, reduced resistance to joint movement, and in turn both increased energy efficiency and lowered energy cost (7). Unfortunately, this review found only two studies that directly compared the energy cost of yoga practiced by experienced versus novice practitioners (26,38), one evaluating Bikram practice (26) and the other focused on pranayamas. In the former, the energy cost of a 90-min Bikram yoga session was 27% higher in experienced compared with novice practitioners (4.7 ± 0.8 vs 3.7 ± 0.5 kcal·kg−1). Experienced practitioners also had a 67% greater elevation in core temperature than novice practitioners despite an 83% higher sweat losses alluding to increased work output in experienced practitioners. The pranayama study was in agreement (38). Experienced practitioners were able to substantially increased oxygen cost during breathing exercises compared with novice practitioners despite a lower oxygen cost at rest. Additional research in this area is certainly needed to help establish how experience influences the energy cost of yoga practice.
Cardiorespiratory indicators of yoga intensity
This review further supports that the evaluation of exercise intensity using %HRmax, %V˙O2max, and %HRR—more commonly used for individual exercise prescription (12)—yields results similar to MET intensity. Using these criteria, the majority of studies also found that yoga does not meet the ACSM criteria for moderate-intensity aerobic activity defined as eliciting an HR in the range 64 to 76%HRmax or an oxygen cost between 46 and 63%V˙O2max. The exceptions include Surya Namaskar (7,23,34), standing Iyengar asana practice with jumps between poses (9), and Bikram practice (26). These practices, except the Bikram session, increased MET values to within the moderate-intensity range. The use of absolute or relative (%HRmax) HR, however, may not be an overall valid indicator of exercise intensity during yoga. Several studies found that HR was disproportionally higher than the corresponding oxygen (energy) cost or MET intensity during both Hatha (7,9) and Bikram (26) yoga. For instance, Clay et al. (7) found that a 30-min session at 2.17 METs (15% of V˙O2R) elicited an average HR response of 67% %HRmax, which is considerably higher than expected (see Table 1) (12). HR was also 28 bpm higher during yoga compared with treadmill walking (133 vs 105 bpm) at a higher MET value (3.5 mph, 4.6 METs). Di Carlo et al. (9) observed that standing Hatha yoga induced higher HR and blood pressure responses (71%HRmax) than brisk walking at 4.0 mph at a higher MET intensity of 5.4 METs (62%HRmax). Disproportionally higher HRs during yoga, which integrates arm movements and forceful isometric contractions, however, are expected. These exercise activities alter the hemodynamic and neural responses and elicit a greater HR response than exercises involving leg muscles and dynamic contractions at similar oxygen cost (20). Higher HR values are also expected during yoga practiced in a hot and/or humid environment because of the reactionary shift in blood flow toward the skin, in attempt to maintain thermal homeostasis, which reduces stroke volume and increases HR to maintain cardiac output (20). Similarly, RPE using the Borg scale may also not be a valid indicator of intensity during yoga. The one study that evaluated RPE found that standing Hatha yoga at 4.1 METs elicited an 18% higher RPE than treadmill walking at 5.4 METs (RPE = 14.8 ± 1.8 vs 12.5 ± 1.5) (9).
Quality of measurement of energy expenditure
All studies included in this review used indirect calorimetry to measure oxygen consumption and carbon dioxide production to thereby calculate the energy cost of yoga. Gases were collected using a variety of apparatuses that included a ventilated hood (during pranayamas) (38), mouthpiece and nose clips (26,32), or face mask (13,23,30,31,33), or used a full-room respiratory chamber (14,22). In the one study that evaluated testing reproducibility, the test–retest reliability of the energy cost of yoga measured in the respiratory chamber was sufficiently consistent with an interclass coefficient of 0.97 (14). Although it is tempting to speculate that use of the mouthpiece or mask might induce restraints on a yoga practice, this review found no indication that the gas collection apparatus affected energy cost. Respiratory chambers have the advantage of allowing freedom of movement without restraints of headgear; however, they are expensive, and metabolic carts have been used most commonly to measure the energy cost and MET intensity of most physical activities (1). For example, the energy costs of videotaped yoga sessions averaged 0.63 kcal·kg−1·min−1 using a metabolic cart (7) and 0.58 kcal·kg−1·min−1 when measured inside a respiratory chamber (14). The quality of data collected, however, was difficult to systematically critique because of lack of reported methodological detail. Therefore, this review had to assume that included studies followed standardized procedures, including calibration of gas and volume analyzers, enforced sufficient control of participant’s intake and exercise before testing, and ensured a steady state in oxygen consumption even during the continuous flow through various asanas (7,14,23,27). If oxygen steady state was not achieved, which typically takes at least a minute with continuous exercise, energy cost would be underestimated. To ensure the collection of reliable and accurate metabolic data, future studies should control diet, caffeine, fluid consumption, exercise, sleep, and medications of study participants at least 24-h before measurement.
The benefits of yoga
Placing the findings of the current review into a larger discussion of yoga’s potential benefits requires consideration of both the benefits gained from physical activity of lower cardiovascular intensity and yoga’s potential to improve strength and balance, affect the nervous system, and help control stress (4). The ACSM acknowledges that exercise at a lower intensity reduces sedentary behavior and may provide health benefits for older and unconditioned individuals (2,12,16). Exercise below the moderate-intensity threshold (12), including the practice of yoga and pranayama (19,25,39), has also been shown to improve metabolic markers of chronic disease (i.e., insulin resistance, blood pressure, and lipid profiles) without the corresponding improvements in V˙O2max. In addition, yoga offers an alternative for individuals who cannot engage in traditional forms of physical activity or who prefer light exercise over more intense aerobic exercise. Yoga is perceived to be a gentler form of exercise and may be a more sustainable means of daily practice for individuals with joint problems, rheumatoid arthritis (17), or back pain (24). A recent review found that yoga was superior to other forms of exercise for improving self-reported health status, aerobic fitness, and muscular strength in older adults (28). For instance, 8 wk of yoga participation improved treadmill walking time to fatigue by 3 min (37). Yoga has also been found to benefit those who are more aerobically fit. A study of distance runners found a small but significant improvement in running performance after a single yoga session (11). Similarly, 24 sessions of yoga performed for 8 wk led to improved balance, leg strength, and leg muscle control in young athletes (15). Many of these benefits may be linked to yoga’s ability to increase strength, balance, and flexibility; to calm the mind; and to reduce stress (4). The ACSM position statement for exercise prescription emphasizes that multifaceted physical activities that involve combinations of neuromotor exercise, resistance exercise, and flexibility exercise, which includes yoga, have numerous benefits beyond cardiovascular fitness (12). Results of this study suggest that certain aspects of yoga practice, particularly the more intense asanas, can count toward the weekly amount of physical activity suggested by the ACSM guidelines (16).
Study limitations
Currently, published studies are somewhat limited in that they were conducted mostly in fairly experienced Indian men (23,30–33,35,36) or women practicing in US metropolitan cities (7,14,27) who were relatively young, apparently healthy, and of normal weight. The exception was for the Wii yoga studies that included Japanese and English adolescents and older individuals (13,22). Results are therefore not generalizable to individuals with obesity or adverse health conditions, the elderly, or the young children. The MET intensities included in this review are also only average summaries from included studies, which rarely reported the full range of oxygen uptake and MET intensities. Consequently, the range of energy cost and MET intensities for yoga asanas, pranayama, or full yoga sessions are not available. Regardless, the review provides information for exercise professionals, yoga instructors, health care providers, and yoga practitioners considering practicing yoga as part of physical activity-related goals. It also provides a summary of MET values that may be useful for future MET tables (1) and exercise guidelines. Future studies are needed to better understand how experience and individual variability influence the energy cost and intensity of yoga.
No funding was received for completion of this project. The author declares no conflict of interest. Results of the present study do not constitute endorsement by the American College of Sports Medicine.
REFERENCES
1. Ainsworth BE, Haskell WL, Whitt MC, et al. Compendium of physical activities: an update of activity codes and MET intensities.
Med Sci Sports Exerc. 2000;32(9 Suppl):S498–504.
2. American College of Sports Medicine, Chodzko-Zajko WJ, Proctor DN, Fiatarone Singh MA, et al. American College of Sports Medicine Position Stand: exercise and physical activity for older adults.
Med Sci Sports Exerc. 2009;41(7):1510–30.
3. Brahmachari D, Vachani S, Sahani S, Ram K, Rai L. A comparative study of some individual yogic postures on ventilatory responses in yoga proficient subjects.
J Res Edu Ind Med. 1989;3:7–17.
4. Broad W.
The Science of Yoga. The Risks and the Rewards. New York: Simon & Schuster Paperbacks; 2012. pp. 310.
5. Carroll J, Blansit A, Otto RM. The metabolic requirements of Vinyassa yoga (abstract).
Med Sci Sports Exerc. 2003;35(5):S155.
6. Cè E, Maggioni MA, Boniello S, Veicsteinas A, Merati G. Anthropometric and physiologic profiles of female professional yoga practitioners and energy expenditure during asanas execution.
J Sports Med Phys Fitness. 2015;55(1–2):51–7.
7. Clay CC, Lloyd LK, Walker JL, Sharp KR, Pankey RB. The metabolic cost of Hatha yoga.
J Strength Cond Res. 2005;19(3):604–10.
8. Corliss R. The power of yoga.
Time. 2001;157(16):54–63.
9. DiCarlo LJ, Sparling PB, Hinson BT, Snow TK, Rosskopg LB. Cardiovascular, metabolic, and perceptual responses to Hatha yoga standing poses.
Med Exerc Nutr Health. 1995;4:107–12.
10. Donnelly JE, Blair SN, Jakicic JM, et al. American College of Sports Medicine Position Stand: appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults.
Med Sci Sports Exerc. 2009;41(2):459–71.
11. Donohue B, Miller A, Beisecker M, et al. Effects of brief yoga exercises and motivational preparatory interventions in distance runners: results of a controlled trial.
Br J Sports Med. 2006;40(1):60–3; discussion −3.
12. Garber CE, Blissmer B, Deschenes MR, et al. American College of Sports Medicine Position Stand: quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise.
Med Sci Sports Exerc. 2011;43(7):1334–59.
13. Graves LE, Ridgers ND, Williams K, Stratton G, Atkinson G, Cable NT. The physiological cost and enjoyment of Wii Fit in adolescents, young adults, and older adults.
J Phys Act Health. 2010;7(3):393–401.
14. Hagins M, Moore W, Rundle A. Does practicing Hatha yoga satisfy recommendations for intensity of physical activity which improves and maintains health and cardiovascular fitness?
BMC Complement Altern Med. 2007;7:40.
15. Hart CE, Tracy BL. Yoga as steadiness training: effects on motor variability in young adults.
J Strength Cond Res. 2008;22(5):1659–69.
16. Haskell WL, Lee IM, Pate RR, et al. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association.
Med Sci Sports Exerc. 2007;39(8):1423–34.
17. Haslock I, Monro R, Nagarathna R, Nagendra HR, Raghuram NV. Measuring the effects of yoga in rheumatoid arthritis.
Br J Rheumatol. 1994;33(8):787–8.
18. Ives JC, Sosnoff J. Beyond the mind-body exercise hype.
Phys Sportsmed. 2000;28(3):67–81.
19. Malhotra V, Singh S, Tandon OP, Sharma SB. The beneficial effect of yoga in diabetes.
Nepal Med Coll J. 2005;7(2):145–7.
20. McArdle W, Katch F, Katch V.
Exercise Physiology. Baltimore: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2014. pp. 303–54.
21. Mees PD. Yoga participation surges—exploring the clinical implications.
Phys Sportsmed. 2005;33(5):12–5.
22. Miyachi M, Yamamoto K, Ohkawara K, Tanaka S. METs in adults while playing active video games: a metabolic chamber study.
Med Sci Sports Exerc. 2010;42(6):1149–53.
23. Mody BS. Acute effects of Surya Namaskar on the cardiovascular & metabolic system.
J Bodyw Mov Ther. 2011;15(3):343–7.
24. Monro R, Bhardwaj AK, Gupta RK, Telles S, Allen B, Little P. Disc extrusions and bulges in nonspecific low back pain and sciatica: exploratory randomised controlled trial comparing yoga therapy and normal medical treatment.
J Back Musculoskelet Rehabil. 2015;28(2):383–92.
25. Naruka JS, Mathur R, Mathur A. Effect of pranayama practices on fasting blood glucose and serum cholesterol.
Indian J Med Sci. 1986;40(6):149–52.
26. Pate JL, Buono MJ. The physiological responses to Bikram yoga in novice and experienced practitioners.
Altern Ther Health Med. 2014;20(4):12–8.
27. Pate RR, Pratt M, Blair SN, et al. Physical activity and public health. A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine.
JAMA. 1995;273(5):402–7.
28. Patel NK, Newstead AH, Ferrer RL. The effects of yoga on physical functioning and health related quality of life in older adults: a systematic review and meta-analysis.
J Altern Complement Med. 2012;18(10):902–17.
29. Payne L, Feuerstein G.
Yoga for Dummies. 3rd ed. Hoboken (NJ): John Wiley & Sons; 2014. pp. 1–32.
30. Rai L, Ram K. Energy expenditure and ventilatory responses during Virasana—a yogic standing posture.
Indian J Physiol Pharmacol. 1993;37(1):45–50.
31. Rai L, Ram K, Kant U, Madan SK, Sharma SK. Energy expenditure and ventilatory responses during Siddhasana—a yogic seated posture.
Indian J Physiol Pharmacol. 1994;38(1):29–33.
32. Rao S. Metabolic cost of head-stand posture.
J Appl Physiol. 1962;17:117–8.
33. Ray US, Pathak A, Tomer OS. Hatha yoga practices: energy expenditure, respiratory changes and intensity of exercise.
Evid Based Complement Alternat Med. 2011;2011:241294.
34. Sinha B, Ray US, Pathak A, Selvamurthy W. Energy cost and cardiorespiratory changes during the practice of Surya Namaskar.
Indian J Physiol Pharmacol. 2004;48(2):184–90.
35. Sinha B, Sinha TD, Pathak A, Tomer OS. Comparison of cardiorespiratory responses between Surya Namaskar and bicycle exercise at similar energy expenditure level.
Indian J Physiol Pharmacol. 2013;57(2):169–76.
36. Telles S, Singh N. High frequency yoga breathing increases energy-expenditure from carbohydrates. Comment to: Assessment of sleep patterns, energy expenditure and circadian rhythms of skin temperature in patients with acute coronary syndrome Hadil Al Otair, Mustafa Al-shamiri, Mohammed Bahobail, Munir M. Sharif, Ahmed S. BaHammam Med Sci Monit, 2011; 17(7): CR397-403.
Med Sci Monit. 2011;17(9):LE7–8.
37. Tran MD, Holly RG, Lashbrook J, Amsterdam EA. Effects of Hatha yoga practice on the health-related aspects of physical fitness.
Prev Cardiol. 2001;4(4):165–70.
38. Tyagi A, Cohen M, Reece J, Telles S. An explorative study of metabolic responses to mental stress and yoga practices in yoga practitioners, non-yoga practitioners and individuals with metabolic syndrome.
BMC Complement Altern Med. 2014;14:445.
39. Vyas R, Dikshit N. Effect of meditation on respiratory system, cardiovascular system and lipid profile.
Indian J Physiol Pharmacol. 2002;46(4):487–91.
40. Yoga Journal Editor. New study finds more than 20 million yogis in U.S. 2012. Available from:
http://www.yogajournal.com/uncategorized/new-study-finds-20-million-yogis-u-s/.
