Stroke survivors do advance floor yoga postures focused on hip and ankle range of motion and strength. (Credit: Image courtesy of American Heart Association)
In a small pilot study, researchers tested the potential benefits of yoga
among chronic stroke survivors -- those whose stroke occurred more than six
"For people with chronic stroke, something like yoga in a group environment
is cost effective and appears to improve motor function and balance," said
Arlene Schmid, Ph.D., O.T.R., lead researcher and a rehabilitation research
scientist at Roudebush Veterans Administration-Medical Center and Indiana
University, Department of Occupational Therapy in Indianapolis, Ind.
The study's 47 participants, about three-quarters of them male veterans, were
divided into three groups: twice-weekly group yoga for eight weeks; a
"yoga-plus" group, which met twice weekly and had a relaxation recording to use
at least three times a week; and a usual medical care group that did no
The yoga classes, taught by a registered yoga therapist, included modified
yoga postures, relaxation, and meditation. Classes grew more challenging each
Compared with patients in the usual-care group, those who completed yoga or
yoga-plus significantly improved their balance.
Balance problems frequently last long after a person suffers a stroke, and
are related to greater disability and a higher risk of falls, researchers
Furthermore, survivors in the yoga groups had improved scores for
independence and quality of life and were less afraid of falling.
"For chronic stroke patients, even if they remain disabled, natural recovery
and acute rehabilitation therapy typically ends after six months, or maybe a
year," said Schmid, who is also an assistant professor of occupational therapy
at Indiana University-Purdue University in Indianapolis and an investigator at
the Regenstrief Institute.
Improvements after the six-month window can take longer to occur, she said,
"but we know for a fact that the brain still can change. The problem is the
healthcare system is not necessarily willing to pay for that change. The study
demonstrated that with some assistance, even chronic stroke patients with
significant paralysis on one side can manage to do modified yoga poses."
The oldest patient in the study was in his 90s. All participants had to be
able to stand on their own at the study's outset.
Yoga may be more therapeutic than traditional exercise because the
combination of postures, breathing and meditation may produce different effects
than simple exercise, researchers said.
"However, stroke patients looking for such help might have a hard time
finding qualified yoga therapists to work with," Schmid said. "Some occupational
and physical therapists are integrating yoga into their practice, even though
there's scant evidence at this point to support its effectiveness."
Researchers can draw only limited conclusions from the study because of its
small number of participants and lack of diversity. The study also didn't have
enough participants to uncover differences between the yoga and control groups.
The scientists hope to conduct a larger study soon.
Researchers also noticed improvements in the mindset of patients about their
disability. The participants talked about walking through a grocery store
instead of using an assistive scooter, being able to take a shower and feeling
inspired to visit friends.
"It has to do with the confidence of being more mobile," Schmid said.
Although they took time to unfold, "these were very meaningful changes in life
Co-authors are Marieke Van Puymbroeck, Ph.D., C.T.R.S.; Peter A. Altenburger,
Ph.D., P.T.; Nancy L. Schalk, R.Y.T.; Tracy A. Dierks, Ph.D; Kristine K. Miller,
P.T.; Teresa M. Damush, Ph.D.; Dawn M. Bravata, M.D.; and Linda S. Williams,
M.D. Author disclosures are on the manuscript.
The Program for Integrative Medicine and Health Care Disparities conducts research in several areas relevant to underserved or ethnic minority populations.
Complementary and Alternative Medicine (CAM) therapies such as supplements, meditation, yoga, massage, and acupuncture are increasingly popular in the U.S. Studies estimate over one-third of U.S. adults use CAM therapies while approximately one of ten children use them. Well-designed research studies need to be carried out to determine which of these complementary therapies are safe and effective and should be therefore integrated into mainstream clinical care. Conversely, if research identifies practices that may be ineffective or unsafe, their use should be strongly discouraged and not combined with conventional medicine.
National surveys also show, however, disparities in CAM use based upon race, income, and education. For example, CAM use is much less common in non-whites, Hispanics, the poor, and people with less education. Although CAM research has increased dramatically in the previous two decades, relatively little has been done with minority or low income individuals.
Our research at the Program for Integrative Medicine and Health Disparities focuses on why these disparities in CAM use exist, their implications, and strategies to address them. As federal, private, and academic stakeholders invest millions of dollars into CAM research, it is imperative that we study the feasibility and effectiveness of CAM and integrative medicine in multicultural communities and vulnerable populations.
Yoga Use in the United States
Yoga will teach you how to use your mind as a resource for healing, instead of feeling at the mercy of an unpredictable body.
Yoga originated in India over 2000 years ago as a complex system of physical, moral, and spiritual principles. Yoga means ‘unify’ in Sanskrit and its traditional purpose was to help the practitioner attain unity of “mind, body, and spirit.” Hatha yoga became popular in the United States during the 1960s. Hatha yoga consists of three core components: physical postures (asanas), breathing techniques (pranayama), and an inward meditative focus.
Dr. Saper and colleagues published the first analysis of U.S. yoga use in their 2004 publication in Alternative Therapies in Health and Medicine. Data from a 1998 national survey of American CAM use were analyzed and they found that 3.8% of the U.S. adult population used yoga in 1998. Twenty-three percent of yoga users were non-white and 21% had an annual income less than $20,000. Ninety percent of respondents who used yoga for specific health conditions perceived it as helpful. Back pain was the most common health condition for the use of yoga: 21% of yoga users reported using yoga for back pain. Gurjeet Birdee MD of Harvard Medical School, Dr. Saper, and colleagues also analyzed data from the 2002 National Health Interview Survey showing that yoga use is increasing: 5.1% of American adults reported using yoga in 2002, making it the fifth most common CAM therapy.
Yoga for Chronic Low Back Pain
Back pain contributes substantially to morbidity, disability, and cost in our society. The impact of low back pain on poor ethnic minority patients may be compounded by health care disparities that impact access to medical providers, CAM providers, adequate pain medications and specialty referrals. Yoga for Low Back Pain (YLBP) was a pilot randomized controlled trial of hatha yoga versus usual medical care for 30 predominantly minority adults with chronic low back pain conducted at two Boston community health centers, Dorchester House Multiservice Center and Codman Square Health Center. We were interested in whether a diverse urban population of back pain sufferers with little previous experience with yoga would enroll in such a study. The results were extremely promising. We had over 200 inquiries and completed enrollment within two months. YLBP found that participants receiving yoga in comparison to those who did not receive yoga had less pain, improved back-related function, and took less pain medication. Our results were presented at the 2009 North American Research Conference in Complementary & Integrative Medicine and was published in the November-December 2009 issue of Alternative Therapies in Health and Medicine. The study was funded through a Career Development Award to Robert Saper, MD MPH from the NIH National Center for Complementary Alternative Medicine.In 2010 Dr. Saper received another NCCAM grant to conduct a comparative effectiveness randomized controlled trial of hatha yoga, physical therapy, and education for chronic low back pain in low income minority populations. In 2011 he conducted a Yoga Dosing Study, Yoga for Low Back Pain 2, which was designed to determine the best dose of yoga for chronic low back pain.
Traditional Systems of Indian Medicine
These Indian systems of medicine and homeopathy received a major boost about a decade ago when they were given an independent identity under the health and family welfare ministry. In 2003, the department was renamed AYUSH.
Traditional Indian Systems of Medicine (TISM) such as Ayurveda and Siddha originated in South Asia over 2000 years ago and are practiced by an estimated 80% of India’s 1.1 billion population. TISM are widely believed in India to be safe and effective. However, we reported in the Journal of American Medical Association in 2004 that 20% of imported South Asian herbal remedies sold in Boston ethnic markets contained potentially harmful levels of lead, mercury, and/or arsenic. A follow-up study published in 2008 also in the Journal of American Medical Association found 21% of TISM medicines sold on the Internet contained detectable levels of these metals. These products were manufactured in both India and the U.S. with similar percentages containing metals.
The CDC reported 12 cases of lead poisoning associated with TISM medicines in five U.S. states between 2000-2003. Contamination from the environment and manufacturing processes are likely partly responsible for the problem. However, TISM experts also describe intentionally adding to herbal formulations bhasmas, which are compounds made with mercury, lead, arsenic, iron, zinc, and other metals. Bhasmas are prepared through an elaborate process that is claimed to change the form of the metal rendering it nontoxic and therapeutic. Recent press resulting from our publications and others have raised global safety concerns and prompted import bans by Canada, USA, Australia, and others. This has generated debate and controversy among key stakeholders within India including TISM practitioners, allopathic physicians, public health professionals, TISM industry, and government.
Our findings were a major impetus causing the Government of India to establish new standards for toxic contaminants in exported Ayurvedic medicines. We have subsequently developed numerous collaborations with traditional practitioners and scientists in the U.S., Canada, and India. We are committed to safe and effective traditional medicine use throughout the world. However, modern scientific methods need to be applied to determine which parts of these traditions are safe, effective, and therefore should be disseminated and promoted; and conversely which aspects are unsafe or ineffective and should therefore be stopped.
Herbs and Dietary Supplements
Many people take herbs and dietary supplements in an effort to stay healthy. A 2007 study found that 52% of adults took at least one supplement as part of their daily regimen. In addition to vitamins like vitamin E, C and B, common supplements include fish oil, glucosamine, and flaxseed oil. Research has shown that some dietary supplements may be effective in preventing or treating disease. For example, folic acid helps prevent certain birth defects, and vitamin D and calcium can help prevent and treat bone loss and osteoporosis (Source: http://nccam.nih.gov/health/supplements/wiseuse.htm). Dr. Gardiner researches herbs and dietary supplements, with particular focus on adverse event reporting of dietary supplements and dietary supplements and pregnancy.
The Society for Oncology Massage (S4OM) addresses the varying needs of the touch practitioner, consumer, and health professional, and provides resources for advancing the knowledge and understanding of oncology massage.
The majority of cancer patients receiving chemotherapy undergo implantation of a permanent central venous access device, often referred to as a port. The port serves as a permanent intravenous device (IV) to deliver chemotherapy. Implantation of the port is an outpatient surgical procedure using local anesthetic only. Patients remain conscious, must keep their head rotated 90 degrees to one side and remain very still during this delicate procedure, which takes approximately 60 minutes. Although the port carries obvious multiple benefits for ease of treatment, after the procedure patients often complain of headaches, muscle stiffness and neck and shoulder pain that lasts for several days. Pain medication is the only therapy commonly offered for this and is often inadequate. Furthermore, since this is often the first surgical procedure for cancer patients at the beginning of their treatment, they often have significant levels of pre-procedure anxiety. Safe, efficacious, and cost-effective interventions that can reduce the anxiety and pain related to port placement are needed.
We are conducting a nine-month pilot RCT of 60 predominantly low-income, minority, cancer patients at Boston Medical Center undergoing Port-a-Catheter placement to assess the feasibility and efficacy of massage therapy for reducing pre-operative anxiety and post-operative pain. The study is supported by a grant from the Massage Therapy Foundation.
Acupuncture is among the oldest healing practices in the world. Acupuncture is one of a number of techniques that comprise a whole medical system called traditional Chinese medicine (TCM). Traditional Chinese Medicine considers the health and balance of the entire system: body, mind, spirit, emotions and environment. The body is understood to be a balance of two opposing and inseparable forces: yin and yang. According to TCM, health is achieved by maintaining the body in a “balanced state” of these two forces. In acupuncture the stimulation of specific points on the body by a variety of techniques, including the insertion of thin metal needles though the skin helps the body maintain or regain it’s balance. According to the 2007 National Health Interview Survey, which included a comprehensive survey of CAM use by Americans, an estimated 3.1 million U.S. adults and 150,000 children had used acupuncture in the previous year. Relatively few complications from the use of acupuncture have been reported to the FDA, in light of the millions of people treated each year and the number of acupuncture needles used.
In 2007 we published a paper describing the establishment of free-care acupuncture clinics within Boston Medical Center with an underserved minority adolescent population. During 2004-2006 the acupuncture clinic had 544 visits for a wide range of conditions, including headaches, a wide variety of pain syndromes, gynecological issues, and gastro-intestinal problems. Visits increased 65 % from the first to the third year of operation. In 2008-2009 we surveyed adult users of two free-care acupuncture clinics at Boston Medical Center. This pilot study surveyed patients satisfaction and perceived helpfulness of acupuncture. Over 24 months, a total of 720 acupuncture treatments were administered, consisting of 144 new patient visits and 576 follow-up visits. Overall satisfaction with acupuncture was reported as either “Very Good” or “Good” in 95% of all surveys. Only 1% of respondents reported that they would not use acupuncture again and 93% stated they would recommend acupuncture to friends or family.This health blog has been provided to you by www.myreliever.com
Performing static stretches before a workout will not properly prepare your muscles for activity. Static stretching should only be performed after exercise to prepare your muscles for recovery.
For an article being published in next month’s issue of The British Journal of Sports Medicine
, researchers at the University of Sydney in Australia reviewed dozens of recent studies of stretching, hoping to determine whether the practice prevents people from getting sore after they exercise. The authors found 12 studies completed in the past 25 years that looked directly at that issue. Most were small and short-term. But each produced essentially the same result, the review authors write, showing that “stretching does not produce important reductions in muscle soreness in the days following exercise.”
That does not mean that you shouldn’t stretch, the study’s authors add, but it does indicate that stretching may not provide the benefits that many of us expect.
Write about fitness, and you soon learn that stretching is one of the more contentious and emotional issues among people who exercise. Those who regularly stretch tend to assume that the practice will prevent soreness and injury. Those who do not stretch frequently claim, with equal fervor, that stretching is a waste of time. A slowly growing body of science suggests that each group has some evidence backing it up, although reliable information about stretching remains hard to come by, in part because stretching is difficult to study.
Everyone can benefit from flexibility. Good flexibility improves posture. Depending upon the type of work we perform, our daily activities can cause tightening in areas that affect posture. Poor posture can lead to pain and discomfort, often resulting in time at the chiropractor or doctor’s office.
Most of us, when we talk about stretching, mean the practice of assuming a pose, like bending over to touch our toes or leaning against a wall to stretch our hamstring muscles, and holding that position until the stretching feels uncomfortable, usually 30 seconds or so. This routine is known as static stretching, and it’s widely practiced by people before or after many types of activities. In one of the studies
included in the new review, about 54 percent of the 2,377 active adult participants said that they regularly performed static stretching, and most added that they stretched in large part to avoid muscle soreness.
But in that study, which was conducted by Robert D. Herbert, a professor at the George Institute for Global Health at the University of Sydney, who also wrote the comprehensive review, the rates of reported muscle soreness were similar regardless of whether the volunteers completed a standard 15-minute program of static stretching. About 32 percent of those who didn’t stretch reported sore muscles the day after a workout. About 25 percent of those who had stretched reported the same.
Other studies have produced comparable data, with one experiment cited by Dr. Herbert finding that static stretching before or after endurance exercise reduced volunteers’ self-reported muscle soreness the next day by a grand total of just half a point on a 100-point scale of discomfort.
“Our interpretation of the data is that, on average, stretching really does reduce soreness, but the reduction is tiny,” Dr. Herbert told me, probably too small to be meaningful in practical terms. Most of us wouldn’t notice much difference in our muscle soreness regardless of whether we stretched. This finding jibes with other, related science suggesting that static stretching is not particularly good at reducing injury risk, either. In the same randomized study by Dr. Herbert, those who stretched experienced about the same number of sports-related injuries as those who didn’t.
But most experts caution that it’s difficult to interpret these results, because no studies of stretching meet the scientific gold standard of being both randomized and blinded. You can randomly assign people to groups that stretch or don’t stretch, of course, but you can hardly disguise from them whether they’re stretching or not. At the same time, volunteers’ subjective opinions about stretching seem to affect study outcomes, too. In Dr. Herbert’s experiment, those volunteers who “strongly agreed” at the start of the study that stretching is important rarely reported sore muscles if they were assigned to the stretching group. If, on the other hand, these stretching enthusiasts were assigned to not stretch, they were more likely than other volunteers to feel that their muscles were now growing sore.
So what does all of this intriguing but still muddled science about stretching mean for those of us who regularly exercise?
“It does not mean that you should not stretch,” said Dr. Michael Fredericson, a professor of sports medicine at Stanford University and the chief physician for that school’s cross-country and track-and-field teams, who recently completed an online report about stretching
. So-called dynamic stretching regimens, during which you move while lengthening muscles and connective tissues, could be more effective than static stretching at reducing injuries and soreness, he says. Try substituting jumping jacks for toe touches before a run, he says. “And if you feel frequent tightness” in certain muscles or tissues, like in the iliotibial band that runs along the outside of your knee, a common occurrence in distance runners, “then stretch those particular muscles after exercise to lessen your chances of serious injury.”
If you’ve never stretched, though, don’t feel obligated to begin now, Dr. Herbert says. “There is little evidence that stretching does anything important,” he says, “but there is also little to be lost from doing it. If you like stretching, then do it. On the other hand, if you don’t like stretching, or are always in a rush to exercise, you won’t be missing out on much if you don’t stretch.”
Every week, 95 million Americans suffer some kind of stress related symptoms for which they take medication.
Nothing can beat regular exercise as a stress
-busting technique. The result of the 'fight or fight' reaction is that our bodies go into a state of high arousal but there is often nowhere for that energy to go, so our bodies can stay in this state for hours at a time. Exercise
is the best way to dissipate the excess energy, especially if you have a sedentary job.
It's a good idea to channel your energy into proper exercise, be it a brisk walk, a run
, a bike ride or a game of squash. You don't need to join a health club
— exercise can be as informal as taking the dog for a walk, or dancing at home to your favorite music.
Experts recommend that we exercise at a moderate intensity for a minimum of 30 minutes, most days of the week. And there are many reasons to do so. Exercise not only improves health and reduces stress, it also relaxes tense muscles and helps you to sleep. It causes the release of chemicals called endorphins into your bloodstream, making you feel relaxed and happy. As such, it can be a helpful tool in fighting depression and anxiety, as well as keeping you trim and reducing your risk of heart conditions
and stroke, managing high blood pressure, diabetes and back pain. All in all, fit people are better able to handle the long-term effects of stress without suffering ill health.
What To Choose Walking
, jogging, swimming, cycling, aerobics classes or DVDs, and dancing are all great forms of exercise. If you choose something you enjoy, it won't feel like a chore.
It is also a good idea to vary your activities to avoid boredom. For example, if you normally exercise indoors, try an outdoor activity.
Exercise should be fun. It's difficult to keep going with an exercise program that you don't enjoy. Exercising with a friend might encourage you to keep it up longer, and try activities that will make you forget you're exercising, such as roller-skating or flying a kite. Excuses, Excuses!
If you find yourself making excuses, write them down and assess each one. Perhaps you say:
· I don't have the time/money.
· I am not the sporty type/no good at exercise.
· I don't enjoy exercise.
· I am too old/tired/overweight/self-conscious.
· There are no facilities close by.
· I can't be bothered.
However, exercise doesn't have to take place at the gym or on a treadmill. Anyone can exercise even without spending money, leaving the house or having a particular skill. And everyone feels better afterwards. Just remember to warm up and cool down, to avoid injury. Walking
Even the least fit among us usually are able to incorporate some walking into our schedules. An organized walking routine can be a great form of aerobic exercise. It's free, and strengthens the heart and lungs as well as the legs. It also helps to prevent osteoporosis, lowers blood pressure and cholesterol, helps with diabetes, and increases flexibility.
Walking for 30 minutes most days can be an easily achievable target, perhaps walking all or part of the way to work, or a 15 minute burst at lunchtime and another in the evening. As your fitness improves, you could even try alternating with a slow jog.
Taking the stairs instead of the elevator is a choice that will become automatic after a short time.
Yoga reduces stress and improves strength, flexibility, coordination, circulation and posture. It may even reduce the frequency of asthma attacks.
Yoga is an ancient Indian practice, dating back more than 5000 years. The word yoga means union, and was originally designed to lead to union of the human spirit with nature. However, today many people use it as a technique to link the body and mind in a way that encourages peacefulness and relaxation. It uses stretching postures, breathing, and meditation techniques to calm the mind and tone the body.
There are different types of yoga, but almost of those used in the West are forms of Hatha Yoga. This is a combination of asanas (physical exercises and postures), pranayamas (breathing techniques) and meditation.
You can learn about yoga from books and videos, but the best way is through attending a class with an experienced instructor.
Also known as tai chi ch'uan, this form of martial art will help to reduce stress and improve strength and flexibility.
Based in the Chinese Taoist philosophy, it was developed for health, self-defense, and spiritual development. It combines a series of gentle physical movements and breathing techniques, allowing you to experience a meditative state. The idea is that it facilitates the flow of chi ("life energy") through the body by dissolving blockages both within the body and between the body and the environment. Through concentration, coordinated breathing and slow, graceful body movements, it aims to increase well-being.
It has recently been found that Tai Chi has physiological and psychosocial benefits and promotes balance control, flexibility, and cardiovascular fitness in patients with chronic health conditions.
Tai chi is now practiced all over the world and, as with yoga, it's best to learn from a qualified teacher.