Post on 04-Jan-2017
SYTAR 2008Saturday 03/08, 2008 (Track 2.01)
Yoga for Respiratory Challenges
Vijai Sharma, PhD, RYT
Program Description
Information about respiratory challenges(Restrictive and obstructive breathing) for yoga practitioners Provides yoga tools and solutions for respiratory challenges Evidence for benefits of yoga asanas and pranayama techniques for lungs and breathing
Biodata
1994: Diagnosed with Emphysema
2007: Completed Quad Bypass with honors
Intention of the Presentation
Informed thinking about a person with respiratory challenges
Tools and Solutions for Challenged breathing
Informed thinking about a person with respiratory challenges
Why Should We Do It?
“Breath is central to yoga because it is central to life”
T. Krishnamacharya
Because…………………..
“When you can’t breathe nothing else matters”
American Lung Association
What Is it Like?
A “straw” and a “squeeze” are worth a thousand words
What it’s like to breathe? (2)
Take a deep breath (dirgh shvasa)Don’t let it outNow, try to take another breath
Major Respiratory Challenges
“Restrictive Breathing” (e.g. PF/or asthma in parts) mainly the problem of getting the air IN
“Obstructive Breathing” (Emphysema/ COPD) mainly the problem of getting the air OUT
Adult Asthma and COPD
Adults with asthma were at 12 times higher risk of acquiring COPD than those without asthma In a longitudinal study 1 in 5 people with asthma developed functional signs of COPD
Results from the Tucson Epidemiological Study of Airway Obstructive Disease and a longitudinal study cited from GOLD 2006, p.31)
Several yoga studies suggest slow breathing
can help
Yoga can help with structural problems
e.g. scoliosis to facilitate breathing
Emotional management and
calming with yoga
Activity planning and
pacing
Avoid allergens, pollution and
smoking
Comments on restrictive breathing
Focus: Chronic Obstructive Pulmonary Disease (COPD)
Shortness of breath (progressive, everyday, worse with exertion, “air hunger”/discomfort)
Chronic cough
Chronic excessive mucus (> McDonald ketch-up bowl a day)
Mild SOB is often explained away
I am getting
I have put on so much
I am out of
Because “I smoke/d”
Moderate SOB
Avoid activities that leave one out of breath
Find “shortcuts.”
*If no troubling symptoms, no medical consult
Severe SOB
Symptoms more than a “nuisance”
Daily activities significantly affected
Typically, doctor is consulted at this point
Some May be “walking” with You
“Millions of airways…provide so much reserve that most people may not notice it if they lost the use of a third or even half of a lung”
– From the smoking Boom Comes a Major killer of women: New York Times, National Thursday, Nov. 29, 2007
Wide-spread “breath illiteracy”
The Hydra Headed COPD
Multiple co-morbid disorders e.g. Heart Disease, Osteoporosis, GERD, Depression, Anxiety etc.
Yoga with its wide-ranging effects on body, breath and mind must be explored
Medical Source Documents
GOLD (Global Initiative for Chronic Obstructive Disease)2006GINA (Gobal Initiative for Asthma) 2006ATS-ERS Pulmonary Rehab Statement 2005
Slightly paraphrased for yoga context
During Exercise/Exertion
Getting the air out of lungs becomes ever more challenging More CO2 builds upWanting to breathe more and faster (air hunger) Lungs over inflate (Dynamic hyperinflation) Leaving less room in the lungs for fresh air to get in
“Vicious cycle” sets in during exercise/exertion
>Work of breathing increases >Breathing discomfort (Dyspnea) >Breath anxiety and activity avoidance <Fitness level
“Virtuous Cycle” with Breath Awareness
Timely breath regulation
Activity modulation and breath pacing
Reduced Dyspnea episodes
Reduced breath anxiety, more yoga, more exercise/activity
“They” and “Us” Want the Same things 1
>Oxygen>Blood flow in the skeletal muscles >Personal/household activity level<Shortness of breath
*Some evidence for exercise training benefits in these areas
“They” and “Us” Want the Same things 2
Improve cardiovascular function Improve emptying out of lungs Reduce mood disturbanceDevelop stress management skills
*Some evidence that exercise training provides benefits in these areas
Relaxation Training
“Relaxation training should be incorporated in the patient’s daily routine…(which) can be accomplished through techniques such as muscle relaxation, imagery, or yoga.”
(*Yoga has all those things!)
Stress Management
“Patient should be …capable of stress management techniques”
(*Yoga increasingly being recognized for stress management)
Tools and Solutions for Challenged Breathing
Evidence based strategies 1
Strength training may increase muscle mass and reduce dyspnea during exerciseShorter sessions w/pause may help progress to a more intensive levelCombination of strength and endurance training is “best strategy”
Evidence based strategies 2
Session ideally 30 minutes or more Three sessions a week of which at least two should be supervised Minimum of 20 sessions
Evidence-based strategies 3 “Both upper and lower extremities (during exercises) should be utilized”
Evidence based strategies 4
“Walking, bicycling, treadmill for endurance training”
(Variety of activity & exercises are needed--Sharma)
*
Yoga Strategy —First Things First
Body, breath and mind relaxation with Shavasana adaptationsLengthening the exhalationSlowing the breathing24-7 Breath awareness and monitoring Control over dyspneaBreath coordinated stretchesPacing of activity with breathing
Yoga Strategy-
Asana that don’t excessively strain the breathingHelp excrete the sputumIncrease the elastic recoil of the lungs
Yoga Strategy- A session should include
Asanas to exercise the whole body (arms, legs and trunk); chair for those who need itMove the spine in every which way (forward, back, lateral, twist, vertical) underutilized in rehab programsCoordinate spinal and other movements with adaptive breathing (underutilized in rehab programs)
Yoga Strategy- Restorative and Relaxing Asana
Nourishment for overworked heart and lungs
Economy of effort for maximum benefits Facilitate strengthening exercisesProgress from “passive” asanas to
more “active” as the condition improves
Yoga Strategy- Consider Props and other Supports
Increase of blood flow for longer duration to various muscles and organs Rest the heart and lungsRelieve fatigue
*Caution: Some props are effort- intensive and unaffordable for home use
Asana effects from pulmonary perspective Source Documents
Bio-Mechanics of Yoga by Dr. Krishna Raman
http://www.medicineau.net.au/columns/yoga/biomech.htm
Yogic Management of Pulmonary Diseases
(Chronic Bronchitis and Emphysema) http://www.webhealthcentre.com/altmed/yoga/yg_tool.asp
Forward bending
Allows lungs and heart to restStretches the posterior part of the lungsRelieves fatigue
*Caution: breathing in Child Pose or chair Uttanasana may be difficult for some
Pulmonary Medicine on Forward Bending
“Forward leaning has been noted clinically to be effective in COPD and is probably the most adopted body position. …..(forward) leaning with arm support, decreases dyspnea, and increases exercise capacity”
Am J Respir Crit Care Med Vol 173. pp 1390–1413, 2006
p.1398
Backward Bending “Heart is stretched out along with the left
ventricle as can be seen on the echocardiogram”
Cardiac muscle is also toned up by molding the supporting structures of the heart (dorsal spine)
Angina lets up “Clear the bronchial tree of mucus” Opens the thoracic cage and create negative
pressure in the lungs Allows blood from the right ventricle to enter
without strain
Lateral Stretch Standing poses(e.g. Triangle & Revolving Triangle)
Expand the intercostals Tone up the lung walls Stretch the lungs
* Utilize chair or wall support when indicated
Twisting Poses(standing, seated or reclining)
Increase the elasticity of intercostals Squeeze and stretch the lungsSqueeze the lateral parts of the lungs
Standing Poses
Leg fatigue a common complaint in COPD
*Standing yoga poses can be helpful but you need to build up the strength gradually
Supine Poses (viz. Supta Virasana, Baddha Konasana with pillows)
“Deep breathing done in these poses ventilates the lungs”Rests heart and lungsRelieves fatigue
Bio-Mechanics of Yoga by Dr. Krishna Raman http://www.medicineau.net.au/columns/yoga/biomech.htm
Supta Virasana and Viprita Karni
“Supta Virasana and Viprita Karni are very useful to remove strain on the heart and reduce the respiratory rate in the emphysematics”
Yogic Management of Pulmonary Diseases (Chronic Bronchitis and Emphysema) http://www.webhealthcentre.com/altmed/yoga/yg_tool.asp
* adaptations may be required
Inversions (e.g. Supported Viprit Karni, Dwiparda pitham)
“10 % increase in the ejection fraction (heart pump) in Setubandha Sarvangasana”“Ultrasound shows that Urdhava Mukha Svanasana improves the flow of blood into the ascending aorta (heart)”
Bio-Mechanics of Yoga by Dr. Krishna Raman http://www.medicineau.net.au/columns/yoga/biomech.htm
Help drainage from the basal parts of the lungs
Yogic Management of Pulmonary Diseases (Chronic Bronchitis and Emphysema) http://www.webhealthcentre.com/altmed/yoga/yg_tool.asp
Pranayama-
“Improves mucocilliary clearance and stamina”
Yogic Management of Pulmonary Diseases (Chronic Bronchitis and Emphysema) http://www.webhealthcentre.com/altmed/yoga/yg_tool.asp
First Dyspnea control, relaxed breathing breath awareness and breath control
Pranayama-
“The practice of Kumbhaka (breath retention) facilitates better percolation of oxygen into the lungs”
Yogic Management of Pulmonary Diseases (Chronic Bronchitis and Emphysema) http://www.webhealthcentre.com/altmed/yoga/yg_tool.asp
Pranayama
“(Lying down on a prop), the strain on the accessory muscles of respiration reduces and he or she can make a `relaxed effort' to empty the lungs.”“The dorsal spine must be supported by a prop. Only then must breathing begin.”
Yogic Management of Pulmonary Diseases (Chronic Bronchitis and Emphysema) http://www.webhealthcentre.com/altmed/yoga/yg_tool.asp
Utilize: Longer and slow exhalation to empty the lungsCoordinated emptying and filling of the lungs lying down, seated, supportedGentle asana coordinated breathing
Cleansing of the respiratory system
Gentle alternate nostril bhastrika Gentle, slow KapalabhatiGentle, slow anuloma-viloma (alternate nostril breathing)
Purrsed Lip Breathing (PLB)-1
PLB compared to spontaneous breathing:Prolongs active expirationHelps to prevent airway collapse.Reduces respiratory rate, dyspnea, and CO2 levelImproves tidal volume and oxygen saturation in resting conditions”
Am J Respir Crit Care Med Vol 173. pp 1390–1413, 2006 p.1398
PLB-2
“…many patients with chronic lung disease use this technique (PLB) instinctively and report decreased dyspnea with its use.”
Am J Respir Crit Care Med Vol 173. pp 1390–1413, 2006 p.1398
Let’s practice P.L.B?
It’s not Shitali or Ujjayi (try them later)Purse your lipsExhale slowly and evenlyMaintain consistent outflow
Later, “OOOOmmm PLB”
Caution on D.B. Training
“To date, evidence from controlled studies does not support the use of diaphragmatic breathing in patients with COPD”
Am J Respir Crit Care Med Vol 173. pp 1390–
1413, 2006 p.1398
How ATS/ERS define DB?
“Diaphragmatic breathing techniques require the patient to move the abdominal wall out during inspiration and to reduce upper rib cage motion”
– Am J Respir Crit Care Med Vol 173. pp 1390–1413, 2006 p.1398
*Instead of claiming DB we should target relaxing neck & shoulder muscles while breathing
Add to the Yoga Practice
Aerobics: e.g. walking, treadmill, elliptical, etc.
Resistance: e.g. light weights
Support group: Local/Online
What to expect with Yoga
Breathing Techniques Dyspnea/ SOB Control Whole Body Fitness
Relaxation SkillsStress management Skills Mental/ emotional
perspective
The Future Winner
After supervised 20/30 sessions, a home-based graduated program that evidences long-term adherence, safety, benefits, wider acceptance and reduced medical cost
Who are the people who adhere and benefit significantly from such a program?
Contact Namaste
Vijaisharma@att.net
www.mindpub.com/copdhome.htm