Yoga and Occupational Therapy
Here is a primer on using yoga with OT intervention:
What is yoga?
Yoga is a practice of mindfulness – listening to own’s body while breathing and moving through various sequences and balancing positions to stimulate the body and mind.
There are many types of yoga. Here are just a few examples:
Hatha – is the oldest and one of the more popular form of yoga and probably the gentlest form on this list. In Hatha Yoga, poses are held for a length of time (say 30-60 seconds) while concentrating on quiet breaths in and out. Hatha yoga is the yoga of choice for a lot of yoga instructors who are willing to adapt yoga for a special population.
Vinyasa – is considered a “flow” type of yoga. After some stretching and warm-up, the movements become more choreographed to breath, hence the idea of “flow” – moving with the breath – movement occur with each “in” and each “out” breath.
Bikram – this is a popular form of “hot” yoga (but not all “hot” yoga is Bikram). Bikram yoga is an intense type of yoga (with it’s fair share of critics). Participants are lead through the same series of 12 poses in a heated and humidity controlled environment. Bikram yoga instructors help clients push their bodies to the limit; the heat and humidity allow participants to move more than they can otherwise. (I would not recommend any of the “hot” yogas to any of your clients who have some type of physical disability – pushing the body beyond its limit for these clients would NOT be safe – find an alternative).
And, these are the various techniques used within all forms of yoga:
Asanas – these are the poses that people think of when they think of yoga (cobra, frog, tree).
Breathing – there are a lot of breathing techniques that can be used in a yoga class. The main focus in the breath is during the asanas – mostly exhaling during a pose that “closes” into the body and inhaling during a pose that “opens” the body to allow the lungs to work at their full capacity (FYI – this can be a great technique to use in OT that can work with most of your clients). Some courses and styles of yoga offer more breath work than others.
Chanting – “Om” is a common word used in yoga classes that helps the yogi focus attention and practice breathing. Some yoga classes stop at “om”; others use chants. The chants can be extremely energizing if one is open to them but, for some, they can be distracting. Proceed with caution with clients who are a bit unsure about yoga – the chanting can be intimidating until they are feeling comfortable with their practice. (Here is an example of chanting in a yoga practice: Hari Om)
Meditation – a period of mindful rest. When meditating, the participant attempts to clear their mind of clutter – taking note of thoughts but not allowing the thoughts to consume them. Meditation can be a challenge for some clients – but with practice, this usually improves. All yoga classes will have some form of meditation. Meditation has its own benefits for many of our clients.
Benefits of yoga
Studies show that yoga can reduce stress and improve autonomic nerve activity and metabolic functions; can improve posture, flexibility, and balance along with executive function; and, a regular yoga practice can also reduce pain (1-5) (you can also read my blog about pain and OT here!). Other studies have found improved mood and responses to stressful situations in those who practice yoga. Systematic reviews and meta-analyses have difficulty coming to the same conclusions, citing poor study design found in many research on yoga and its benefits, but the most recent reviews are more promising (6-12).
In OT interventions – There is a group of researchers at Colorado State University looking at use of yoga combined with OT for stroke survivors with fall risk. Preliminary results show that the combination may improve balance and fall risk in this at-risk group (13). Positive results and future studies such as this will help improve the evidence-base for OTs using yoga as an intervention!
Learn more about yoga
- There are specific programs for therapists to learn how to use yoga in their practice (realizing that OTs have advanced knowledge about the body and how to approach clients, especially with disabilities) – Yoga for the Special Child (link here) is one (I am a certified Yoga for the Special Child practitioner – Sonia is great and you will learn about yoga and how to use it with children with disabilities in this series of yoga trainings). There are other courses that help you use yoga as a therapeutic intervention. Click here for one example.
- Do yoga yourself!! It is a great way to get an understanding of what yoga is all about!!
- Wheelchair or chair yoga is offered at many community centers and nursing homes, you can observe or participate in a course if you are close to one – you will get an idea of how yoga techniques can be adapted for people of varying abilities.
- Read about it – The Anatomy of Hatha Yoga (by H. David Coulter) is a great book for anyone wanting to know more about the how’s and why’s of yoga. I also know that there are “tons” (well, maybe not tons, but a lot) of yoga books for kids that I think are great. Kids books do a great job way conceptualizing some of the most popular yoga poses. If you work with kids, these books are a great way for children to visualize the poses and have fun with yoga.
Using yoga in OT interventions
There are registered yoga teachers who spend many hours in yoga training to teach yoga (the initial certification is 200 hours for a RYT – registered yoga teacher) – they know how to teach yoga and are taught how to accommodate various levels of ability within their classes. You don’t need to be an RYT to use yoga techniques in OT but you should be familiar with yoga by being a regular yoga practitioner yourself and take further training on yoga if you plan to use it within your particular intervention setting. If you are both an OT and an RYT, great!!
These are the steps I suggest for an OT who wants to try out yoga with clients as an intervention.
1) Find clients who might benefit from yoga and advocate for them to try it. You could use yoga techniques as part of a morning wake-up routine with individuals in group homes, schools, or other residential facilities to familiarize groups with the yoga poses, breathing, and meditation.
2) Educate your clients on the benefits of yoga (see above!).
3) Practice some yoga techniques in your OT sessions. If a client needs adaptations, help them problem solve how they need to approach various yoga challenges. One key in yoga is to help people become mindful of the limits of their body. If you are an OT using yoga techniques within your OT sessions, you can reinforce that everyone has to do yoga differently, the idea is to become aware of your body’s capabilities and work within those capabilities. Clients should be doing this anyhow – yoga can be one more way to help them learn more about their body.
4) Find a local yoga studio that practices a yoga style that would work for your client. A lot of local communities on aging will have chair or wheelchair yoga classes, plus they are usually provided at a reasonable price. Your clients who are middle-aged adults can look for a local studio.
If your client has cognitive impairments or psychosocial difficulties that makes this process difficult, incorporate this into your treatment sessions. For example, work on functional living and communication skills –using the internet or local library to find places to do yoga, calling yoga studies and asking about their prices and classes, asking for a preview of a class before they buy a package, which leads me to the next point…
5) Practice money management with your clients who need it – yoga can be expensive in urban centers but packages are usually available that can save your client some money. If you client has troubles with money, explore options for saving or getting a yoga course at a discount. Some managed care organizations or employee health plans provide an incentive for getting involved, have your client call their insurer and ask if yoga counts.
6) Once you have identified the appropriate local practice, practiced yoga techniques with your client, and they are ready to participate in a yoga class on their own, make sure that you have some sort of monitoring system to keep track of how they are doing with the class. If you are finding that your client is having a hard time in a mainstream yoga class, ask if they want you to advocate for them and educate the yoga instructor on their skills or needs. Or, if your client has a mental illness and has some anxiety with their performance in a yoga class, maybe you can go with them a few times (it can benefit both of you!).
7) Follow up with your client after they have been practicing yoga on their own. Remember that it takes a while to develop a habit (some sources say upwards of 3-6 months!). You want to make sure that your client keeps up with their practice, especially if it seems to be a good fit for them. Be a support for them and encourage them to keep going to get the most benefit out of their practice.
Hope this helps, fellow OTs! Let me know your thoughts about this one!!!
- Centrella-Nigro, A. (2017). Evaluating the Addition of Hatha Yoga in Cardiac Rehabilitation. MEDSURG Nursing, 26(1), 39-43
- Chen, N., Xia, X., Qin, L., Luo, L., Han, S., Wang, G., & … Wan, Z. (2016). Effects of 8-Week Hatha Yoga Training on Metabolic and Inflammatory Markers in Healthy, Female Chinese Subjects: A Randomized Clinical Trial. Biomed Research International, 20161-12. doi:10.1155/2016/5387258
- Devan, D. (2014) A review of current therapeutic practice for the management of chronic pain. South African Journal of Occupational Therapy, 44(1).
- Hua, C., Yuh-Jen, L., Wen-Lan, W., Yu-Kai, C., & I-Mei, L. (2015). Effects of Yoga on Heart Rate Variability and Mood in Women: A Randomized Controlled Trial. Journal Of Alternative & Complementary Medicine, 21(12), 789-795.
- Lin, S., Huang, C., Shiu, S., & Yeh, S. (2015). Effects of yoga on stress, stress adaptation, and heart rate variability among mental health professionals – a randomized controlled trial. Worldview on Evidence-Based Nursing, 12(4), 236-245.
- You-Yin, W., Hsiao-Yun, C., & Chen-Yu, L. (2014). Systematic Review of Yoga for Depression and Quality of Sleep in the Elderly. Journal Of Nursing, 61(1), 85-92. doi:10.6224/JN.61.1.85
- Abel, A. N., Lloyd, L. K., & Williams, J. S. (2013). The Effects of Regular Yoga Practice on Pulmonary Function in Healthy Individuals: A Literature Review. Journal Of Alternative & Complementary Medicine, 19(3), 185-190. doi:10.1089/acm.2011.0516I-doi:10.1089/acm.2015.0138
- Desveaux, L., Lee, A., Goldstein, R., & Brooks, D. (2015). Yoga in the Management of Chronic Disease: A Systematic Review and Meta-analysis. Medical Care, 53(7), 653-661. doi:10.1097/MLR.0000000000000372
- Jeter, P. E., Slutsky, J., Singh, N., & Khalsa, S. S. (2015). Yoga as a Therapeutic Intervention: A Bibliometric Analysis of Published Research Studies from 1967 to 2013. Journal Of Alternative & Complementary Medicine, 21(10), 586-592. doi:10.1089/acm.2015.0057
- Luu, K., & Hall, P. A. (2016). Hatha Yoga and Executive Function: A Systematic Review. Journal Of Alternative & Complementary Medicine, 22(2), 125-133. doi:10.1089/acm.2014.0091
- Patel, N. K., Newstead, A. H., & Ferrer, R. L. (2012). The Effects of Yoga on Physical Functioning and Health Related Quality of Life in Older Adults: A Systematic Review and Meta-Analysis. Journal Of Alternative & Complementary Medicine, 18(10), 902-917. doi:10.1089/acm.2011.0473
- Ward, L., Stebbings, S., Cherkin, D., & Baxter, G. D. (2014). Components and reporting of yoga interventions for musculoskeletal conditions: a systematic review of randomised controlled trials. Complementary Therapies In Medicine, 22(5), 909-919. doi:10.1016/j.ctim.2014.08.007
- Schmid, A.A., Puymbroeck, M. Van, Portz, J.D., Atler, K.E., & Fruhauf, C.A. (2016). Merging Yoga and Occupational Therapy (MY-OT): A feasibility and pilot study. Complement Ther Ed, 28, 44-49.