Mind over Yoga.

Yoga is a Hindu spiritual discipline that developed thousands of years ago in India. The word "yoga" means "to join"--to unite the mind, body and spirit in harmony. Hatha yoga, the physical aspect of this discipline, combines movement, breathing, and mental focus and has become a generic name for a cornucopia of yoga styles.

What does science say of its benefits? And what do people report?

Growing popularity

According to a 2002 study, yoga was used by more than 5% of the US population. It's even more popular among people with MS. Various surveys suggest that 10-30% of people with MS have used yoga.

Studies in MS and other conditions

Despite its popularity, there has been only one quality study of yoga and people with MS. The study from the Oregon Health Science University * looked at the effect of yoga and aerobic exercise on cognitive function, fatigue, and mood in 69 participants assigned to conventional exercise, yoga, or nothing. After six months, both those who did yoga and conventional exercise showed decreased fatigue as measured in two fatigue measurement tests. However, no effect was detected on mood or cognitive function using standard measures. That may be because there is no such effect, or because the study was too small or the study duration was too short to detect an effect.

In the general population however, in at least five studies of yoga using various controls and comparisons, yoga seemed to be an effective treatment for depression. Other studies suggest that yoga may decrease anxiety and stress.

Yoga's effect has been studied with other diseases. In asthma, yoga reduced medication use and increased lung function. For people with arthritis, yoga helped decrease joint pain and improve joint movement. Yoga has also been shown to decrease heart rate and lower blood pressure in people with cardiovascular disease.

How yoga might work

Yoga is an example of "mind-body" medicine. Other examples include prayer, tai chi, hypnosis, guided imagery, and meditation. These forms of CAM also involve some combination of movement, breathing, and mental focus to influence health. In scientific terms, mind-body modalities may influence the brain, which can influence the immune system, hormones, and involuntary functions such as blood pressure and heart rate, all for the better.

Yoga is a form of exercise. Exercise in general is known to provide numerous health benefits for people with (or without) MS. Exercise can improve muscle tone and cardiovascular heart health, and, of special interest to people with MS, may increase the production of proteins in the brain ("growth factors") that stimulate nerve growth.

What people report

Despite limited evidence from research, people with MS who practice yoga have been enthusiastic about its benefits. Surveys suggest that people with MS have used yoga most frequently to treat stiffness, to help relax, and to improve balance.

Cautions

Yoga is relatively inexpensive and generally safe. It's not associated with any significant adverse effects for people with MS. However, people can get pulled muscles or sprains. Avoid vigorous styles of yoga and difficult postures if you have fatigue, heat sensitivity, or impaired balance; a serious lung, heart, or bone condition; significant spine problems, such as herniated discs; if you have had surgery recently; or are pregnant.

Yoga can be a valuable and rewarding complement to your conventional therapy, provided you find an appropriate class and a good teacher.

A head for yoga: how to find what's right for you

You may not be able to do a head stand. But do use your head when you look for a yoga teacher. The Yoga Alliance Web site (www.yogaalliance.org) lists dozens of yoga styles that run the gamut from aerobic to meditative. To find something that suits you:

Consult a health care provider before starting. Let your fitness level guide you.

Read up. An overview of yoga styles was published by Yoga Journal (www.yogajournal.com/newtoyoga/165.cfm). Those with gentle practices include lyengar, Anusara, Kripalu and Viniyoga.

Find a class. Your chapter (1-800-FIGHT-MS) may offer yoga programs or can refer you to resources. Check hospitals and recreation centers. Ask physical therapists and other health-care providers. No class for people with MS? Look for a beginner, gentle or "therapeutic" class, or one targeted to seniors or to people with other conditions such as arthritis.

Group classes are one to two hours and cost around $15 a session. Private instruction costs more but may be worthwhile on occasion for individual attention.

Consider the teacher. Ask about style, teaching experience, and certification. Does the teacher have expertise in adapting yoga for people with special needs? A teacher should have a basic knowledge of anatomy. Having a PT or health background is a plus. Tell the instructor about your physical issues. To check a teacher's background, visit www.yogaalliance.org, which sets educational standards for yoga schools and teachers.

Check out the class. Action speaks louder than words. Observe or take a trial class. Is it small enough for individual attention? Is the instruction clear? Modified poses or alternatives should be offered for those with limitations. Are props available and used? Will you feel comfortable with the pace?

Play it safe. Avoid injury. Speak up if a position is uncomfortable. Yoga should be about accepting what you can do today.

About videos. If you have never had a class, a video isn't the best route for a first taste of yoga. Videos can help sustain a practice at home but choose carefully. Two therapeutic videos made with MS in mind are "Yoga for MS and Related Conditions" (www.mobilityltd.com/pathways.htm) and "Yogability and You" (www.yogabilityandyou.com).

Resources. International Association of Yoga Therapists (www.iayt.org) lists teachers who have varying alternative and therapeutic backgrounds.

It's important to tell your physician about any supplements or complementary treatments you are considering or taking. It's equally important that your physician listen respectfully to your questions and concerns regarding CAM.

* Oken BS, Kishiyama S, Zajdel D, Bourdette D, et al. Randomized controlled trial of yoga and exercise in multiple sclerosis. Neurology 2004;62:2058-2064.

Allen C. Bowling, MD, PhD, neurologist, and Tom Stewart, JD, PA-C, certified physician assistant, are both at the Rocky Mountain MS Center in Englewood, Colorado, which hosts the MS-CAM program. For more information about CAM, or complementary and alternative medicine, go to www.ms-cam.org.