Yoga is an ancient system that harmonizes mind, body, and breath through various practices. When this practice is used for the prevention and treatment of medical conditions, it is known as medical yoga therapy.
Medical yoga therapy is multi-component and disease-specific, while yoga classes may be used to promote generalized well-being. Western healthcare systems have historically relegated yoga as a sports and fitness regimen, with limited traction as a valid medical intervention. However, a growing body of scientific evidence on yoga as therapy has demonstrated improved health outcomes across a variety of medical conditions such as breast cancer, chronic back pain, cardiovascular disease, type 2 diabetes, and mood and thought disorders. Moreover, yoga therapy is extremely unlikely to interfere with conventional medical treatments. Yet, yoga therapy continues to receive limited integration within Western healthcare systems.
There are signs the tide is slowly changing. The National Health Service (NHS) in the United Kingdom is steadily striving toward universal integration of medical yoga therapy throughout its healthcare system via the social prescribing initiative. Social prescribing, or community referral, is one of the pillars of the NHS’ long-term plan for personalized care. It is an adjunct to clinical medicine that links patients to community resources and programs to improve health and well-being.
Social prescribing aims to address many of the “hot topics” in medicine such as determinants of health, loneliness, health inequities, and health resource usage through non-clinical means. Offerings are vast and diverse and may include sports, art activities, debt advice, befriending, gardening, and counseling. These prescriptions are tailored to the patient’s needs, interests, and local resources. Yoga therapy is an exceptional offering due to its health benefits, lack of major interference with medical treatments, community penetrance, and acceptability.
The NHS commissioned the Yoga in Healthcare Alliance (YIHA) charity to design a standardized evidence-based multi-component yoga intervention (Yoga4Health) for universal delivery through the social prescribing pathway.
Yoga4Health was specifically designed for patients with risk factors for:
- Cardiovascular diseases
- Mild-to-moderate anxiety or depression
- Social isolation
The 10-week intervention consists of weekly two-hour sessions of group education and discussion, breathwork, posture (asana) practice, and relaxation – with a maximum of 15 patients per class. Modifications, as well as mat and chair versions of the program, were designed to account for patients of all levels of physical ability. Home practice is supported by course manuals, videos, and handouts. Patients can self-refer or are directly referred to the program by a healthcare provider or by an NHS social prescribing link worker.
Here are three important takeaways from the program:
- Evidence-based standardized medical yoga therapy programs promote the integration of yoga therapy in healthcare systems. Several reasons have been suggested for the underutilization of medical yoga therapy within healthcare systems. These include the dearth of reproducible, scientifically validated programs that meet Western medical system benchmarks for improved patient care. Initial evaluation of the efficacy of the Yoga4Health program found significant improvements in patient activation, perceived stress, anxiety, depression, social connectedness, and sense of well-being, and a decrease in waist circumference. These findings were sustained three months post-intervention. The program is standardized, reproducible, and cost-efficient. By meeting these and other benchmarks, Yoga4Health received accreditation by the Royal College of General Practitioners- Personalized Care Institute and is now available across the UK.
- Collaborating with yoga teachers or therapists to deliver standardized medical yoga therapy programs creates an emerging career path in healthcare while expanding treatment options for more patients. As health systems buckle under increased demands, clinician burnout, and limited resources, mobilizing the role of non-clinical healthcare providers to support healthcare delivery is pivotal. By upskilling existing yoga teachers or therapists to deliver evidence-based standardized medical yoga therapy programs for specific conditions, healthcare systems will be able to offer health education and intervention to a significant number of patients per visit. Programs like Yoga4Health have the potential to be comparable to group visits, which has far-reaching ramifications for reducing the chronic disease and healthcare resource burden. Currently, there are over 225 certified Yoga4Health teachers.
- Patients enjoyed the Yoga4Health program and continued practicing yoga after program completion. Many patients stated they found the yoga classes and group dynamics enjoyable which translated into an improved sense of well-being and connectedness. They found the live sessions and supplemental information appropriate for their ability and health conditions. Patients continued to practice yoga, on average, two days per week at three months post-intervention, utilizing course materials such as the course manual and videos as well as community yoga classes. Barriers to sustaining a yoga practice were the cost of community classes followed by lack of time. Only four percent of patients reported a lack of interest in continuing.
While further studies of the Yoga4Health program are needed, the successful integration of the standardized program through mobilizing community resources serves as inspiration for reproducing similar models in other healthcare settings.