ObjectiveAn effective career in medicine requires empathy and compassion, yet the demands of a medical education increase stress and decrease students’ ability to connect with patients. However, research suggests mind-body practices improve psychological well-being. This study aimed to evaluate the psychological effects on medical students of an 11-week elective course, Embodied Health or EH, which combines yoga and meditation with neuroscience didactics.MethodsThe effects on 27 first- and second-year medical students were evaluated via surveys in four areas: empathy, perceived stress, self-regulation, and self-compassion. Scales used were 1. Jefferson Scale of Physician Empathy, which measures empathy among health students and professionals and medical students on a scale of 1 (least empathetic) to 7 (most empathetic); 2. Cohen's Perceived Stress Scale, a measure of the perceived uncontrollability of respondents' lives, from 0 (least stressed) to 4 (most stressed); 3. Self-Regulation Questionnaire, which measures the development and maintenance of planned behavior to achieve goals, from 1 (least self-regulated) to 5 (most self-regulated); and 4. Self-Compassion Scale, which measures self-criticism, from 1 (least self-compassionate) to 5 (most self-compassionate). Students also reflected on EH's impact on their well-being in a post-course essay.ResultsSelf-regulation and self-compassion rose 0.13 (SD 0.20, p = 0.003) and 0.28 (SD 0.61, p = 0.04), respectively. Favorable changes were also seen in empathy and perceived stress, which went up by 0.11 (SD 0.50, p = 0.30) and down by 0.05 (SD 0.62, p = 0.70), respectively; these changes did not reach statistical significance. Students’ essays were found to discuss the following recurrent themes: 1) Reconnection between mind and body; 2) Community in a competitive environment; 3) Increased mindfulness; 4) Confidence in use of mind-body skills with patients; and 5) Stress management. These themes overlapped with the measures EH affected quantitatively.ConclusionA mind-body course for medical students increased self-regulation and self-compassion. Qualitative themes discussed in students’ post-course essays reflected these effects.

Slow breathing increases cardiac-vagal baroreflex sensitivity (BRS), improves oxygen saturation, lowers blood pressure, and reduces anxiety. Within the yoga tradition slow breathing is often paired with a contraction of the glottis muscles. This resistance breath “ujjayi” is performed at various rates and ratios of inspiration/expiration. To test whether ujjayi had additional positive effects to slow breathing, we compared BRS and ventilatory control under different breathing patterns (equal/unequal inspiration/expiration at 6 breath/min, with/without ujjayi), in 17 yoga-naive young healthy participants. BRS increased with slow breathing techniques with or without expiratory ujjayi (P < 0.05 or higher) except with inspiratory + expiratory ujjayi. The maximal increase in BRS and decrease in blood pressure were found in slow breathing with equal inspiration and expiration. This corresponded with a significant improvement in oxygen saturation without increase in heart rate and ventilation. Ujjayi showed similar increase in oxygen saturation but slightly lesser improvement in baroreflex sensitivity with no change in blood pressure. The slow breathing with equal inspiration and expiration seems the best technique for improving baroreflex sensitivity in yoga-naive subjects. The effects of ujjayi seems dependent on increased intrathoracic pressure that requires greater effort than normal slow breathing.

ObjectivesDespite the popularity of yoga and evidence of its positive effects on physical and mental health, little is known about yoga practice in the UK. This study investigated the characteristics of people who practise yoga, reasons for initiating and maintaining practice, and perceived impact of yoga on health and well-being.Design, setting and participantsA cross-sectional online anonymous survey distributed through UK-based yoga organisations, studios and events, through email invites and flyers. 2434 yoga practitioners completed the survey, including 903 yoga teachers: 87% were women, 91% white and 71% degree educated; mean age was 48.7 years.Main outcome measuresPerceived impact of yoga on health conditions, health outcomes and injuries. Relationships between yoga practice and measures of health, lifestyle, stress and well-being.ResultsIn comparison with national population norms, participants reported significantly higher well-being but also higher anxiety; lower perceived stress, body mass index and incidence of obesity, and higher rates of positive health behaviours. 47% reported changing their motivations to practise yoga, with general wellness and fitness key to initial uptake, and stress management and spirituality important to current practice. 16% of participants reported starting yoga to manage a physical or mental health condition. Respondents reported the value of yoga for a wide range of health conditions, most notably for musculoskeletal and mental health conditions. 20.7% reported at least one yoga-related injury over their lifetime. Controlling for demographic factors, frequency of yoga practice accounted for small but significant variance in health-related regression models (p<0.001).ConclusionThe findings of this first detailed UK survey were consistent with surveys in other Western countries. Yoga was perceived to have a positive impact on physical and mental health conditions and was linked to positive health behaviours. Further investigation of yoga’s role in self-care could inform health-related challenges faced by many countries.

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The emergence of yoga therapy in the United Kingdom began about 45 years ago with the emergence of yoga therapy organizations that offered both treatment and training. The integration of yoga into the National Health Service (NHS) is gradually happening Because: (a) yoga research supports its efficacy as a cost-effective, preventive and complementary treatment for a host of non-communicable diseases; and (b) the escalating economic burden of long-term conditions is overwhelming the NHS. The NHS is actively developing 'sustainability and transformation plans' that include yoga. Chief among these is 'social prescribing,' which empowers patients with complex health needs through activities groups. These activities reduce sedentary habits and social isolation, while helping patients to be more self-reliant. The NHS has allocated £450 million in funding to implement a variety of programs for its own staff, in which staff yoga classes were expressly mentioned. The yoga community is mobilizing forces and applying for funding to pilot relevant NHS staff yoga courses that can support the service in achieving its vision. Research shows that integrating yoga therapy for the treatment of low back pain (LBP) into the NHS would result in significant cost savings as compared with usual care. The National Institute for Health and Care Excellence (NICE) Guidelines on LBP and sciatica include yoga as one of the recommended treatments for these conditions. Three groups of yoga teachers, using different yoga practices, have gained traction with the NHS for the application of yoga therapy to LBP. Many regional hospitals in England have yoga classes. The NHS Choices website, which conveys information to the public regarding treatment options, has a page dedicated to the health benefits of yoga. Several institutions offer comprehensive training programs in yoga therapy and yoga therapy is recognized as an official profession. The Yoga in Healthcare Alliance has been established to help integrate yoga therapy into the NHS. This consists of parliamentarians, leaders in the NHS, yoga researchers, health professionals, and representatives from leading yoga organizations.

This chapter describes the physiological mechanisms that underpin the varying effects of different types of breath practices inherent in the yoga tradition and ultimately the role that breathing techniques play in person and public health. Concurrently, the script elucidates how different practices alter psycho-physiological states clarifying why and how they may be employed with specific health populations, how they may enhance and or maintain well-being, and clear guidance regarding precautions and contraindications.

As a multi-tiered biopsychosocial system focused on mental development, yoga aligns with principles of modern mental healthcare. This paper explores mechanisms through which yoga offers its salutatory effects and guidance for its further integration into the NHS.