In the last few years, yoga has resurfaced as an exercise, not to mention fashion, craze. One of the remarkable things about this historic Indian form of exercise and relaxation is that is can be tailored to the fantastically fit or those with physical limitations. And a number of studies have shown that yoga may have specific health benefits for people with joint pain, insomnia and even those with certain lung diseases. A study funded by the National Center for Complementary and Alternative Medicine at the National Institutes of Health recently examined its benefits in people with multiple sclerosis (MS).
Lead researcher Barry Oken, MD, director of the Oregon Center for Complementary and Alternative Medicine in Neurological Disorders in Portland, was interested in providing health professionals with data that would allow them to recommend specific exercise strategies. His study randomized 69 people with MS to one of three groups for six months. One group attended a weekly yoga group and the second group went to a weekly aerobic exercise group run by a physical therapist; the exercise involved riding at stationary bicycle in class and at home. The third group maintained their normal state of activity.
Below, Dr. Oken discusses his study's finding that people in both the yoga and aerobic exercise groups experienced less fatigue, and what people with MS should keep in mind when choosing an exercise program.
Why did you decide to look at the benefits of yoga in MS patients?
I thought that yoga might be beneficial in terms of cognitive function in multiple sclerosis, where there are significant cognitive problems, such as difficulty concentrating. So cognitive function was the primary outcome measure in the study, and the all the quality of life measures such as fatigue and mood were secondary outcome measures.
Yoga and aerobic exercise have a lot of similar properties, but yoga might offer some other plusses. Yoga has a stress reduction or relaxation component, which may be helpful for people with MS or other conditions. For example, you concentrate on your breathing. People who are doing aerobic exercise may be doing that as well, but it may not be quite as overt. Yoga also improves joint flexibility through stretching, which is not as important in most exercise routines. Joint flexibility may be good in arthritis and other kinds of joint symptoms.
There are also yoga poses where there is significant strengthening of, for example, the shoulder girdle muscles, which is not happening if somebody is running or doing an exercise bicycle. And yoga improves balance.
What did the yoga classes involve?
We chose to do a 90-minute Iyangar yoga class because Iyangar lends itself to easy adaptability with props. A lot of the patients needed chairs, blankets and other props in order to be able to do the poses because they had problems with balance and strength.
After a fair amount of work, we designed a series of poses that we thought would be feasible for people with MS. There were more restorative or rest poses than there would be in a standard class, and poses weren't maintained for as long as they might be in a normal class; poses were only held for about 10 to 30 seconds. The class was pretty structured, with each week being fairly similar to the previous week.
What did the study find?
There was no improvement in cognitive measures, actually. The changes were in the measures of fatigue. Statistically, the improvements in fatigue were equivalent in the bicycling and yoga groups.
Fatigue in MS is a major issue. More than three-quarters of people who have MS have significant fatigue. There are a couple of causes of this fatigue. Some people who are depressed may complain of fatigue, and depression is not uncommon in multiple sclerosis. But even people who are not depressed—and those who do have not significant physical disability—have problems with fatigue, to the point that there are prescription medications that are used to treat the fatigue in MS.
The results of our study, however, might have been partly due to the class structure. There was a bit of a support group atmosphere because it was a group of people with MS who were doing this exercise class together.
Do you think exercise should be recommended to people with MS?
Ten years ago, doctors were recommending that people with MS not exercise. At this point, I think the recommendation should be that people with MS should engage in some kind of exercise program, be it aerobic exercise, such as the stationary bicycle, or yoga. The reason we stress the stationary bicycle is that, unlike walking, it is a physical exercise that people with MS can continue fairly readily as the disease progresses. And swimming is sometimes impractical.
While our yoga results may be translatable to somebody with MS taking a general yoga class, I'm not sure of it. Certainly, the yoga class attended by someone with MS has to be fairly tailored to them. So I'm not sure people who have significant symptoms from MS should just go into the corner yoga studio. The National Multiple Sclerosis Society has been interested in yoga and has been recommending it, and there is the sense that people with MS want yoga classes. We published the design of the class so yoga teachers could have access to what a class specifically designed for people with MS should look like.
Personal trainers working with people with MS on aerobic exercise need to be fully attuned to limitations as well. For example, overheating is an issue in MS. MS damages myelin, a protective coating that covers the nerves. As best we know, electrical conduction in the nerves doesn't function as well when you lose the myelin covering of the nerves. And so, the body is more sensitive to high temperature changes than it would be if there was good myelin covering of the nerve.
Still, I think people with MS should engage in some form of physical activity, be it aerobic exercise or yoga, or whatever exercise they think they can maintain for a number of years.