The Therapeutic Use of Yoga with Sat Bir Khalsa

By Richard Mahler

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    "I have a long-standing interest in the field," notes Khalsa, who spends time in India each year meeting with yoga science researchers and attending professional gatherings associated with meditation and yoga. "I also lecture internationally - most recently in Hong Kong - on the past, present, and future of yoga research." He will give an overview talk on this theme at the NIH Yoga and Mind-Body Medicine conference this September.
 
    An assistant professor of medicine at Harvard Medical School, Khalsa teaches an elective Mind-Body Medicine course through which medical students are invited to attend an after-class yoga session. "About half the students participate in the latter," says Khalsa, with the remainder required to experience and to report on some form of mind-body intervention. "The class itself consists of a 75-minute lecture, often delivered by leaders not only in the field of yoga but also in biofeedback, tai chi, mindfulness meditation, and other modalities."

    Khalsa is a logical choice for someone to describe basic and applied yoga research to both lay and professional audiences, providing broad overviews or precise details as needed. Based on work begun in the mid-1970s, he compiled a comprehensive summary of clinical yoga research for a paper published in the Indian Journal of Physiology and Pharmacology and for a chapter published in the authoritative 2004 book, "Principles and Practices of Stress Management."

    This compilation "is now a little out of date," Khalsa concedes, "but I do try to keep up." He helps coordinate the research component of the annual Symposium on Yoga Therapy and Research of the International Association of Yoga Therapists as well as for meetings of the Alternative Medicine Symposium.

    But the researcher is committed to conducting his own research, too. The most recent projects under Khalsa's direction include a randomized study being carried out in a Massachusetts high school whereby yoga sessions substitute two or three physical education classes each week. Mental health and psychological measures for participants are being compared with students in a control group that has continued with standard physical education. Preliminary data, according to Khalsa, suggests improvement among the yoga students in their resilience and anger control.

    The other new research project, for which subjects have not yet been recruited, will evaluate the therapeutic impact of yoga on veterans and active members of the U.S. military who have been diagnosed with post-traumatic stress disorder. The intervention will consist of 20 yoga classes presented over a 10-week period, with results compared to the pre-intervention baseline measures.

    "People used to think that yoga had religious cachet," Khalsa told interviewer John Weeks. "Now, with scientific support, we see the potential for yoga's place in health care and education systems. This is by far the greatest potential value of yoga research, since in order to be incorporated into these systems the effectiveness of yoga will have to be documented through quality research." Over time, it is hoped, the cumulative effect of such studies will help yoga therapies become more integrated into the culture of mainstream Western medicine.


Richard Mahler is a free-lance writer and editor based in Silver City, New Mexico. In 2000 he received professional training as a facilitator of Mindfulness-Based Stress Reduction and since then he has taught MBSR in California and New Mexico. The author of "Stillness: Daily Gifts of Solitude"
and 10 other books, Richard's by-line has appeared in Yoga Journal, Body + Soul, Alternative Medicine, and the Los Angeles Times, among many other publications. Learn more at www.RichardMahler.com


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Regular Yoga Practice is Associated with Mindful Eating

Study suggests that mindful eating can play a key role in long-term weight maintenance

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The follow-up study, published in the August issue of the Journal of the American Dietetic Association, confirms their initial hunch."In our earlier study, we found that middle-age people who practice yoga gained less weight over a 10-year period than those who did not. This was independent of physical activity and dietary patterns. We hypothesized that mindfulness - a skill learned either directly or indirectly through yoga - could affect eating behavior," said Kristal, associate head of the Cancer Prevention Program in the Public Health Sciences Division at the Hutchinson Center.

The researchers found that people who ate mindfully - those were aware of why they ate and stopped eating when full - weighed less than those who ate mindlessly, who ate when not hungry or in response to anxiety or depression. The researchers also found a strong association between yoga practice and mindful eating but found no association between other types of physical activity, such as walking or running, and mindful eating.

"These findings fit with our hypothesis that yoga increases mindfulness in eating and leads to less weight gain over time, independent of the physical activity aspect of yoga practice," said Kristal, who is also a professor of epidemiology at the University of Washington School of Public Health.

Kristal, a yoga enthusiast for the past 15 years, said that yoga cultivates mindfulness in a number of ways, such as being able to hold a challenging physical pose by observing the discomfort in a non-judgmental way, with an accepting, calm mind and focus on the breath. "This ability to be calm and observant during physical discomfort teaches how to maintain calm in other challenging situations, such as not eating more even when the food tastes good and not eating when you're not hungry," he said.

To test whether yoga in fact increases mindfulness and mindful eating, Kristal and colleagues developed a Mindful Eating Questionnaire, a 28-item survey that measured a variety of factors:

• disinhibition - eating even when full;
• awareness - being aware of how food looks, tastes and smells;
• external cues - eating in response to environmental cues, such as advertising;
• emotional response - eating in response to sadness or stress; and
• distraction - focusing on other things while eating.

Each question was graded on a scale of 1 to 4, in which higher scores signified more mindful eating. The questionnaire was administered to more than 300 people at Seattle-area yoga studios, fitness facilities and weight-loss programs, among other venues. More than 80 percent of the study participants were women, well-educated and Caucasian, with an average age of 42. Participants provided self-reported information on a number of factors, including weight, height, yoga practice, walking for exercise or transportation and other forms of moderate and strenuous exercise.

More than 40 percent of the participants practiced yoga more than an hour per week, 46 percent walked for exercise or transportation for at least 90 minutes per week and more than 50 percent engaged in more than 90 minutes of moderate and/or strenuous physical activity per week.

The average weight of the study participants was within the normal range - not surprising considering that the study sample intentionally consisted of people more physically active than the U.S. population in general. Body-mass index was lower among participants who practiced yoga as compared to those who did not (an average of 23.1 vs. 25.8, respectively).

Higher scores on the mindfulness questionnaire overall (and on each of the categories within the questionnaire) was associated with a lower BMI, which suggests that mindful eating may play an important role in long-term weight maintenance, Kristal said.

"Mindful eating is a skill that augments the usual approaches to weight loss, such as dieting, counting calories and limiting portion sizes. Adding yoga practice to a standard weight-loss program may make it more effective," said Kristal, who himself scored high on the mindful-eating survey and has a BMI within the normal range.

Moving forward, Kristal and colleagues suggest that their Mindful Eating Questionnaire, the first tool of its kind to characterize and measure mindful eating, may be useful both in clinical practice and research to understand and promote healthy dietary behavior.

"Beyond calories and diets, mindful eating takes a more holistic approach that can empower individuals to build positive relationships with food and eating, said first author Celia Framson, M.P.H., R.D., C.D., a former graduate student of Kristal's - and former yoga teacher - who now works with adolescents with eating disorders at Seattle Children's Hospital. "The Mindful Eating Questionnaire offers a new and relevant dimension for measuring the effectiveness of dietary behavior interventions. It also encourages nutrition and medical practitioners to consider the broad scope of behavior involved in healthy eating," she said.

Other authors on the paper included Denise Benitez, owner of Seattle Yoga Arts; Alyson Littman, Ph.D., an epidemiologist at the UW School of Public Health and Department of Veterans Affairs; Steve Zeliadt, Ph.D., of VA Puget Sound Healthcare; and Jeanette Schenk, R.D., a research dietitian in the Hutchinson Center's Cancer Prevention Program.

Fred Hutchinson Cancer Research Center funded the study.

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Mindful Musings  Copyright © 2009  eMindful

Editor: Kelley McCabe  Writer: Richard Mahler 
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