How Yoga Helps with Medical Conditions: Prevention

by Baxter (with Nina)

Hygieia by Gustav Klimt

In our post 5 Ways Yoga Can Affect Your Health from a while back, I identified six ways that yoga helps with your health. And although that way of framing how yoga supports good health is still accurate, Nina and I recently realized we could simplify our list of six into a more helpful list of three: 1) prevention, 2) symptom improvement, and 3) as an adjunct to other forms of treatment. Today, I want to discuss what we mean by �prevention.� To put it simply, this means you are using yoga to: 

1. Prevent diseases or conditions from developing.
2. Prevent a disease or condition that you already have from getting worse. 

Now let�s take a closer look at both of these ways you can use yoga for prevention.

Preventing Diseases or Conditions from Developing  

One valuable way you can use yoga for prevention is to promote your overall health in general. Yoga is particularly effective for this because a well-rounded yoga practice that includes an active asana practice, stress management practices, and equanimity practices can help prevent diseases and conditions caused by sedentary behavior and/or chronic stress, such as obesity, heart diseases, cancer, and diabetes. Because a well-rounded asana practice includes active strength, flexibility, balance and agility practices, yoga can also help prevent problems related to being sedentary, including osteoporosis, sarcopenia, balance problems, and falls. And yoga�s stress management practices are good preventative medicine for fostering good emotional and mental health, at the same time they helps foster physical health.

Another valuable way to use yoga for prevention is to focus on preventing a particular disease or condition that you�re concerned about. For example, if you have risk factors for osteoporosis, you can emphasize strength practices to build both bone and muscle strength. Or, if you have cardiovascular diseases running in your family, you can emphasize cardiovascular health practices to prevent the development of high blood pressure, heart attacks, strokes, irregular heart rhythms, and congestive heart failure.

Preventing Diseases or Conditions from Getting Worse 

If you already have a medical condition, depending on the type of condition, you may be able to focus on preventing it from progressing further. Yoga is particularly beneficial for conditions that benefit from working on physical skills, cardiovascular practices, and stress management. In general, some conditions that yoga can help prevent from getting worse include: osteopenia, osteoporosis, sarcopenia, arthritis, diabetes, and high blood pressure. 

Here are a few examples of how it works: If you have sarcopenia of the muscles or osteopenia and osteoporosis of the bones, you can focus on appropriate strength-building practice to hold the condition at bay and in the case of osteopenia prevent it from progressing to osteoporosis and, in some cases, even reversing it somewhat. If you have arthritis, you can focus on flexibility practices to prevent more loss of mobility in your joints, sometimes delaying or maybe even avoiding a joint replacement.

And if you already have high blood pressure, you can focus on lowering your numbers with asana and stress management practices to prevent it from progressing to heart attack, stroke, irregular heart rhythm, or congestive heart failure.

For All Types of Prevention 

Keep in mind that yoga alone may not be enough for the best prevention approach. So you may need to combine yoga with other preventive strategies that your family doctor recommends, such as more aerobic activities or special dietary recommendations. But yoga is a great complement to western medicine. The ultimate goal is your ongoing wellness!

And it is equally important to remember there are no guarantees, and eventually with age and time, we will have to face some serious illness. But it is surely worthwhile to try to delay them in the meantime!

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Sitting is the New Smoking

by Nina

Woman Smoking by Kitagawa Utamaro

�Being out of shape could be more harmful to health and longevity than most people expect, according to a new, long-term study of middle-aged men. The study finds that poor physical fitness may be second only to smoking as a risk factor for premature death.� �Gretchen Reynolds, New York Times 

Have you heard the phrase �Sitting is the New Smoking� yet? Because recently I�ve been hearing it more and more often. And although lthough Ram didn�t use it in his recent post The Ill Effects of Prolonged Sitting he did say, �For people who engage in prolonged sitting activities, their risk of heart attack is about the same as smoking.� 

His post cited three different studies that showed the dangers of spending too many hours a day sitting. (That post got me to spend more time standing up at my sit-stand desk!) Then just a week later I read a NY Times article Being Unfit May Be Almost as Bad for You as Smoking about a new study on the longevity of men who were active versus those who were inactive (they measured aerobic capacity to indicate the subjects' general level of activity and fitness). What was special about this study was that it focused on a large group of about 1,000 healthy Swedish men of age 50, and followed them through the rest of their life spans (45 years!). (Many of these types of studies in the past have been done on older people for much shorter periods of time.)

The conclusion of the study Low aerobic capacity in middle-aged men associated with increased mortality rates during 45 years of follow-up was this:

�In this representative population sample of middle-aged men, low aerobic capacity was associated with increased mortality rates, independent of traditional risk factors, including smoking, blood pressure and serum cholesterol, during more than 40 years of follow-up.� 

And not only was poor fitness/low aerobic capacity second only to smoking as a risk factor for increased mortality, it was actually even unhealthier than high blood pressure or high cholesterol! Yes, the study found that the men who were rated as highly fit but who had high blood pressure or high cholesterol levels tended to live longer than men who were rated as �out-of-shape� but who healthy blood pressure and cholesterol levels. 

And although the study just focused on men (an ongoing problem in scientific studies), the NY Times reported that: 

But �there is no reason not to think� that the rest of us would also share any beneficial associations between fitness and longevity, said Per Ladenvall, a researcher at the Sahlgrenska Academy at the University of Gothenburg, who led the study. Past studies involving women have found such links, he said. 

Perhaps I am preaching to the choir by sharing this information (because you may already be practicing yoga on a regular basis and understand all its many benefits), but for those who are not yet physically active or who have family members or friends who are not active, the takeaway is clear: start being more physically active! The New York Times article concluded by quoting the Dr. Ladenvall saying that even small amounts of physical activity can have a positive effect.

�Encouragingly, if you now are concerned about the state of your particular aerobic capacity, you most likely can increase it just by getting up and moving. �Even small amounts of physical activity,� Dr. Ladenvall said, �may have positive effects on fitness.�

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Featured Pose: Warrior 3 (Virabradrasana 3)

by Baxter and Nina

Warrior 3 challenges your balance very differently than many other balance poses, as you need to resist gravity to keep your body parallel with the floor. Balancing in Warrior 3 is not only a bit more difficult, but it also takes more strength and energy to maintain your balance Keeping your body parallel with the floor strengthens all the muscles along the back of your body, including your buttocks and the backs of your thighs as well all your back muscles from your lower back up to the base of your neck and out into your arms. At the same time, you are stretching your legs, hips, front body and shoulders.

Moving gracefully in and out of the pose takes a combination of strength, flexibility, balance, and agility, so you can use to pose to cultivate all four essential skills. And in general this pose is very stimulating and energizing.

Baxter prescribes this for:

• Improving balance
• Improving hip flexibility
• Building back body strength
• Building upper body strength for those who can�t bear weight on the arms
• Improving concentration and focus
• Energizing the body and mind 

Timing: If you are an experienced practitioner, hold the pose for 1-2 minutes (or until your muscles become shaky). If you are new to the practice, start by holding this pose for 30 seconds, working up to 1-2 minutes over time. Rest for a few breaths afterwards in Mountain pose before moving on to your next pose. You can also practice the pose dynamically. From Warrior 1 position, exhale and come into Warrior 3, then inhale and return to Warrior 1. Repeat 4-6 times on each side. 

Cautions: If you have low back pain, try version 4 or bend your lifted leg. If you experience any other types of pain in the pose, come out and ask your teacher for guidance. 

1. Classic Version

Start by coming into the classic version of Warrior 1 pose. From there, pivot onto the ball of your back foot and tip your torso forward about 45 degrees over your right hip joint. On an exhalation, straighten your right leg as you slowly lift your left leg behind you and bring your torso and arms down to parallel with the floor.

Once in you�re in the pose, focus on keeping your hips even with the floor and reach your arms straight forward, with your head slightly lifted (easier for balance) or aligned with your spine (more challenging) and your gaze slightly forward.

To come out of the pose, bend your right knee slightly, and bring your left foot back and down to floor into Warrior 1 position. From there, release your arms to your sides and straighten your front leg, and turn your feet parallel. Repeat on the left side. 

2. Using the Wall

For those of you who are weak, have balance problems, or are afraid of trying the versions in the middle of the room, this variations is the perfect way to start! It's also an excellent way to warm up for any of the other versions.

Start by coming into Half Downward-Facing Dog at the wall. From there, step your left foot toward your right foot, to the mid point between your feet, and allow your hips to shift a little to the left so more of your weight is on your left foot. Next, keeping your hips parallel with the floor, swing your right leg up and back, in line with your arms and torso.

Once you�re in the pose, focus on keeping your arms, chest, and right leg in a straight line, without letting your chest or belly sag toward the floor. To challenge your balance, try lightening the press of the hands on the wall or come onto your fingertips. 

To come out of the pose, lower your left foot to floor, returning to Half Downward-Facing Dog pose at the wall. Then bend your knees and slowly walk forward to standing upright, about one foot from the wall. Release your hands from the wall and shake out your wrists for few breaths. Repeat the pose on the left side.  

3. Arms Back

If you have shoulder problems or don�t feel strong enough for the classic pose, this version is for you. It�s also easier to balance in this version, so it�s good way to work toward to the classic version, or just to warm up for it. 

Start by coming into Warrior 1 pose with your arms by your sides instead of overhead, From there, pivot onto the ball of your back foot and tip your torso forward about 45 degrees over your right hip joint. On an exhalation, keeping your arms by your sides, straighten your right leg as you slowly lift your left leg and bring your torso parallel with the floor.

Once in you�re in the pose, focus on keeping your hips even with the floor and reaching your arms back along your sides, with your head slightly lifted (easier for balance) or aligned with your spine (more challenging) and your gaze slightly forward. 

To come out of the pose, bend your right knee slightly, and bring your left foot back and down to floor into Warrior 1 position with your arms by your sides. From there, straighten your front leg, and turn your feet parallel. Repeat on the left side.

4. Tilted Part Way 

(sorry, no photo)

If you have tight hips or tight hamstrings and can�t come to parallel with the floor in the full version, or if you want to slowly work your way from the wall version to the full version, this variation is for you. It�s also a good way to warm up for the classic version.

Start by coming into the classic version of Warrior 1 pose. From there, pivot onto the ball of your back foot and tip your torso forward about 45 degrees over your right hip joint. On an exhalation, straighten your right leg as you slowly lift your left leg up slightly as you tip your torso into an angle that�s comfortable for you, creating a long, straight line from your left heel to your fingertips. Once in you�re in the pose, follow the alignment instructions for the classic pose.

To come out of the pose, bend your right knee slightly, and bring your left foot back and down to floor into Warrior 1 position. From there, release your arms to your sides and straighten your front leg, and turn your feet parallel. Repeat on the left side. 

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Free-cycling vs. Recycling Books on Aging

by Nina

In my neighborhood, we�re big into free-cycling. For those of you who don�t know what that means, for us in Berkeley free-cycling means putting things you no longer want or can�t use�clothes, household goods, knickknacks, books, CDs, furniture, etc.�on the sidewalk so that anyone who wants them can simply pick them up and take it home. I�m both a giver and taker (have found some interesting things!), but mostly a giver. I�m so dedicated to this practice, that it almost hurts me to actually just recycle something (or, God forbid, throw something out). In fact, when a friend of mine was downsizing recently due to a divorce and I heard that she was planning to her old books to the dump, I begged her to give them to me so I could �get rid� of them for her by free-cycling them. And indeed as odd a collection of books as it was�old, new, fiction, non-fiction, obscure, common, young adult, super sophisticated.�it only took a matter of days before those hundreds of books were completely gone. 

So when Brad came home the other day with a stack of books on aging that a colleague of his had left behind, I sorted them into two piles: 1) scientific books about mechanisms of aging that I wanted to keep and 2) mass market books on �how to stay young forever� that I intended to free-cycle. Now if you�ve read our posts about aging you might be able to guess why I didn�t want to keep those stay young forever books. As I said in my post, What is Aging, Anyway? 

�if someone out there tells you they can �stop� or even �reverse� aging�I've heard both claims myself�you should be very skeptical. Because right now with so much unknown about aging, there is no proof that any of these anti-aging solutions are effective (and, in some cases, like overuse of certain supplements or human growth hormones, they could actually harm you).� 

And, of course, the very person who helped me understand the importance of that message and encouraged me to spread it was none other than my husband, Brad (aka Dr. Bradford Wayne Gibson), who for 16 years studied aging as a medical researcher at the Buck Institute for Research on Aging.

Anyway, after making my two stacks, I checked with Brad to see whether he agreed with my assessment. He gave me the thumbs up, except when I went to take the �how to stay young forever� books outside for free-cycling, he quickly grabbed them away from me. He said, �Oh, no, you don't. I don�t want ANYONE to read those books� and he tossed them all into the paper recycling bin. Whoa. I was shocked for a moment, but then the importance of his action really struck me. Yes, the irresponsible snake oil about aging that is written and published by people out to make a quick buck really does deserve to be reduced to a pulp. 

On Friday the recycling truck took away all the stay young forever books for processing, and one day soon they�ll have promising new lives as fresh, blank paper.

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Video of the Week: Dynamic Standing Forward Bend (Forward Fold)

This mini vinyasa combines Mountain Pose, Arms Overhead Pose, and Standing Forward Bend (aka Forward Fold). This sequence warms up your spine as it stretches and strengthens your legs and shoulders. Before practicing, watch it once through to see both arm variations.

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Help Wanted: Shari Ser Needs an Assistant!

by Nina

Frequent contributor to our blog, Shari Ser, who is both a physical therapist and a long-time yoga teacher, needs an assistant for her Yoga for Health class at the Berkeley Yoga Room, on Tuesdays, 3�4:15 pm. Her teaching partner, Bonnie Maeda, had to take a leave of absence. Please let us know if you�re interested in helping Shari. You can leave a comment on this post or email Shari at cloudgate1@sbcglobal.net.

Here's how Shari describes the position.

�What I am looking for is an assistant who is interested in teaching seniors who are physically frail but they are the most amazing group of students I have ever taught. They are so inspiring in their attitudes and approaches to life. They literally come no matter what. It is a great opportunity to learn hands on how to teach seniors. We do a "real " yoga class; sitting, standing, and floor work. They are worked to their abilities consistently and it is a lot of fun.�

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How Yoga Fosters Respiratory System Health

by Nina

Big Sur Clouds by Melina Meza

In our post 6 Strategies for Using Yoga to Help with Medical Problems, Baxter and I identified six basic strategies that you can use on their own or in combination to address a wide variety of medical conditions. Today I�m going to conclude my recent series about these individual strategies with this overview how you can use yoga to foster respiratory system health. (See Friday Practical Pointers: Your Respiratory System is more than Just a Pair of Lungs for information about what your respiratory system is and the individual components that comprise it.)

First of all, you can use both asanas and breath practices to maintain the health of your respiratory system overall. In general, asanas that move your spine in all directions of movement, and that stretch and strengthen the muscles all around your upper torso, will help support your respiratory system by keeping respiratory muscles strong and flexible. And breath practices that lengthen your inhalation and exhalation, such as gradual lengthening of equal breath, or that include rapid inhalations and exhalations, like Skull Shining breath, can exercise your breathing muscles even more. 

Yoga asanas, breath awareness, and pranayama can help with mild asthma and COPD by improving breathing efficiency and decreasing inflammation. Baxter�s, students report that their regular yoga practice has been helpful for exercise-induced asthma, which can affect younger adults, but can also arise in older adults.  

CAUTION: Yoga has mixed reviews on its benefits for moderate to severe asthma. For this specific condition, we recommend working with a very experienced teacher.  

Exercise 

In addition to keeping your respiratory muscles strong and flexible, you can use your asana practice to reverse changes to your body due to aging, physical habits, injuries, and scoliosis, that negatively impact your ability to breath. These include structural changes to both muscles and fascia of your chest as well as the chest wall bones and thoracic spine. 

In general, you can reverse changes by: 

1. Improving your posture by strengthening back spinal muscles.

2. Increasing movement in your chest and spine by regularly stretching your chest muscles all directions.

3. Improving the flexibility and strength of your respiratory muscles and fascia by regularly practicing a combination of well-balanced asana sequences and breath practices. 

You can also use asanas to target specific problem areas. For example, if you are developing more rounding of the thoracic spine, adding more dynamic and static back bending postures into your practice can help reduce the rounding. You can also use asanas to strengthen weak chest muscles around your lungs. For example, you can use Plank, Side Plank, and Upward Plank poses to strengthen the muscles around your chest wall and active back bending poses, such as Cobra or Upward-Facing Dog pose, to strengthen your back and front chest muscles.

Breath Awareness 

Your ability to breathe in a healthy way can be compromised by unhealthy breathing patterns, such holding excessive tension in your abdominal muscles. However, by practicing breath awareness with special attention to the movements of your chest and belly, you can learn about your particular breathing patterns and potentially identify any problems. 

In normal, healthy breathing, as you inhale, your chest and ribs will expand slightly and your belly will rise up or bulge forward, and as you exhale, your belly will relax back and your chest and ribs will relax back toward center. Although not common, there are two different breathing patterns that occur in some people that can be problematic:  

Chest Breathing. Instead of your belly expanding on your inhalation and relaxing back on your exhalation, there is no movement in your belly at all. All the movement during respiration is in your chest alone.  

Reverse Breathing. Instead of your belly expanding on your inhalation, it actually sucks in during the inhalation and your chest expands dramatically. And on your exhalation, your belly rises as your chest relaxes.

To observe your own breathing patterns:

1. Start by setting yourself up in a comfortable reclined pose, such as Savasana or Reclined Cobbler�s pose, or a comfortable supported seated pose, such as Easy Sitting pose with your back against the wall.
2. Take a moment to relax completely and breathe naturally, with an easy, relaxed breath.
3. Keeping your breath easy and relaxed, turn your awareness to your chest and belly as you inhale and exhale. Just watch. Is your belly rising/expanding/bulging with your inhalation and relaxing back with your exhalation? Or is something else going on?

If you do identify a problematic breathing pattern�or think that you have�unless you are a very experienced practitioner of pranayama, it�s best for you to work with your yoga teacher or yoga therapist to change your breathing habits. Your present pattern of breathing is likely to be a well-established one. And an expert will not only be able to observe your breathing with a trained eye but will also have techniques available to effectively coach you to change your ingrained habits.

Breath Practices 

A well-rounded breath practice, that includes calming, balancing, and simulating practices, can promote the health of your respiratory system by improving the strength and flexibility or your chest muscles and fascia as well as improving the alignment of your ribs and spine. In general, you�ll benefit from actively challenging your diaphragm with practices that extend the length of the inhalations and exhalations, and that include inhalation and exhalation pausing. 

In addition, recent studies have shown that pranayama is effective in improving lung function in those with chronic obstructive pulmonary disease (COPD. For this condition, equal lengthening of the inhalation and exhalation is recommended. 

Finally, breathing practices that calm your nervous system, such as extending the exhalation or pausing at the end of it, add the benefit of lowering overall stress, which can be particularly helpful to people who are challenged by a respiratory condition.

See Calming Breath Practices We Recommend, Stimulating Breath Practices We Recommend, and Breath Practices for Balance.

Stress Management 

Like the rest of your body, your lungs and the rest of your respiratory system need downtime to rest and repair. In the Rest and Digest state, your respiratory system will get a good rest because you don�t need as much oxygen in this state, so lungs and respiratory system won�t need to work as hard! And, of course, spending time in the Rest and Digest state provides the optimal setting for the system to heal from problems and repair itself. 

So spending time in the Rest and Digest state provides an important break that will foster the health of the entire system. In addition, reducing stress also has positive effect on your immune system, which could lower your chances of getting infections of the respiratory tract, from your nose and mouth all the way into the deep part of your lungs. 

Because many people with chronic respiratory conditions experience ongoing anxiety or other negative emotions related their condition, those who have breathing problems can improve the quality of their lives by practicing stress management. This will help quiet your mind and calm your emotions as well as resting your respiratory system. However, if you have respiratory system problems, meditating on your breath can actually cause stress if you worry about breathing. So if this is the case for you and you want to meditate, we recommend either choosing a different type of focus, such as a mantra, or using a simple guided meditation. 

See Techniques for Supportiing Your Respiratory System for specific recommendations on how to practice.

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Frozen Shoulder, Part 2

by Baxter

Anatomical Studies of the Shoulder by Leonardo da Vinci

For those of you out there who might have missed Nina�s original post on frozen shoulder from a while back (see Yoga and Menopause: Frozen Shoulder), I�d highly recommend it. And while Nina rightly points out a correlation between menopause and adhesive capsulitis (that�s its fancy name), it turns out that men fall victim to this conditions as well. In fact, I developed a case of it in my left shoulder over the fall and early winter months of 2015-16!

Some interesting statistics on and features of frozen shoulder: 

• It usually affects those over 40 years of age, with the peak period being between 40-70 year of age. 
• 70% of cases are women and 30 percent are men. 
• The jury is still out on what causes frozen shoulder. Although there is a connection between menopausal changes in women and the development of frozen shoulder, the other leading contenders are that it is an inflammation problem, an autoimmune problem, or simply a stiffening of the joint capsule problem (a process called fibrosis). 
• Since it does not always show up in isolation, it can be accompanied by other causes of shoulder pain, such as bursitis or rotator cuff injuries, making diagnosis and treatment tricky. 
• According to the Mayo Clinic, you are at higher risk of getting it if you have diabetes, heart disease, Parkinson�s disease, thyroid conditions, or a recent trauma that immobilizes your arm such a fracture or stroke.

When I started getting pain and limited range of motion in my left shoulder and arm last fall, I was not sure what was going on. It came on gradually and I did not have any of the risk factors I had read about, but I had tweaked my shoulder 15 years ago while climbing and had some chronic stiffness that my yoga usually worked out nicely. And then there were two events in September. First, I was swinging on a low trapeze bar for about two minutes, after which I noticed that my shoulder was not so happy with me. And, second, two weeks later I took a trip to an indoor sky-diving place, where a total of four minutes in the wind tunnel with the arms in bird-wing position made my shoulder even more unhappy. I recently came across research that connects direct or indirect trauma to the shoulder joint as a common cause of secondary frozen shoulder, which could explain my case.

When I finally got into to see the orthopedic specialist in late January of this year, initially I was offered a couple of steroid injections to cover both rotator cuff injury and frozen shoulder. At that point I asked for an MRI, since my physical exam could not confirm either diagnosis (it�s good to keep in mind that history and exam don�t always tell you what is going on for sure). And the MRI showed a healthy rotator cuff and definite frozen shoulder, so I only really needed one injection! That very same day, I got into to see an amazing physical therapist, who gave me a set of exercises to begin immediately. From a Yoga for Healthy Aging perspective, I was delighted to discover that some of the exercises were dynamic movements (similar to Arms Overhead Pose), done in sets of 10 repetitions, and others were static movements, held between 2-5 minutes. When I asked about the longer holds, my physical therapist mentioned that the joint capsule, made up of thick connective tissue, requires longer holds to loosen, similar to the timing we�ve discussed for stretching fascia here on the blog.

Now, I had read the studies that the average time for recovery of range of motion was 1-2 years and that really did not fit into my plans, so I asked the physical therapist if he had ever had a patient who recovered faster. He said, yes, one person who had actually taken his advice to do the physical therapist exercises hourly during the day had seen a rapid recovery in just a few weeks! (He pointed out that most patients only do them infrequently.) That was all the incentive I needed, and I started my practice immediately that day. After all, abhyasa (yogic practice) is not all that different (see Practice)!

One of the challenges of rehabbing frozen shoulder is that you actually have to move into far enough into stretch that it is painful. This is in contrast to physical therapy for rotator cuff injuries, where you would not go to the point of pain. I found that my ability to focus on my breath while holding painful stretches for 2-5 minutes was invaluable in staying the course without over triggering my sympathetic nervous system. And although I did not do them every hour, I often got 3-4 sessions in every day for the next few months. By April, my pain-free range of motion in that left shoulder was back to normal, and my physical therapist bid me farewell, with the important reminder to keep an eye on my right shoulder, as 25% of those with frozen shoulder will get a case of it showing up in the opposite shoulder in the 2 years that follow (Nina had this happen).

My takeaways:

1. If stiffness and pain persist in your shoulder, get it checked out by a specialist to get a solid diagnosis.
2. Try to see the best physical therapist you can in your community�it can make a difference.
3. Apply your yogic practice skills and your yoga tools to your rehab. (I was doing all the yoga poses I could do, although with left arm modified, along with my physical therapy exercises, and I believe it helped!).

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SOS for Mental Distress

by Beth

Fire Rescue by Norman Rockwell*

My latest episode of mental distress started last spring. In spite of eight hours of sleep a night and eating healthy 90% of the time, I felt tired, irritated, and mentally fogged. My digestion was off and I was experiencing road �irritation� (thankfully, many degrees away from road �rage�). I just wanted my days to be over so I could plop on the sofa, do jigsaw puzzles on my iPad, and "check out."

I needed to change something. To help me find out what and why, I turned to the koshas (or kosa). This model, a multi-dimensional view of the human being at all levels, has its roots in the Taittirya Upanishad and predates the Yoga Sutras by 1000 years (see Working with the Witness). The levels (or bodies) are: 

• Physical Body (anamayakosha)
• Breath-Energy Body (pranamayakosha)
• Mental-Emotional Body (manomayakosha)
• Wisdom-Witness Body (vijnyanamayakosha)
• Bliss Body (anandamayakosha) 

In Light On Life: The Journey to Wholeness, Inner Peace and Ultimate Freedom, B. K. S. Iyengar refers to the kosha model as �layers of an onion or the Russian dolls, where one is nested within the other.� Clearly, my onion needed some serious peeling! My first step was to assess myself at all levels, kosha by kosha. Using my Wisdom-Witness body, I found discomfort and imbalances at all levels: 

Physical Body: Episodes of acid reflux and constipation resulting from poor digestion.

Breath-Energy Body: My breathing, at times, was shallow and I felt drained.

Mental-Emotional Body: My thoughts and feelings were moving between states of irritation, impatience, and a feeling of failure.

Bliss Body: I felt generally disconnected and out of sorts. 

What to do? Certainly I could turn to my yoga practice. The importance of using yoga to balance and integrate the koshas is implicit in Iyengar�s words:  

�It is essential for the follower of the yoga journey to understand the need for integration and balance in the kosa. For example, the mental and intellectual bodies (manomaya and vijnanamaya kosa) must function effectively in order for us to observe, analyze and reflect what is happening in the physical and energetic bodies (anamaya and pranamaya kosa) and make adjustments.� 

An adjustment was SO needed. Yes, Legs Up the Wall pose would calm my mind, but I also needed to get to the root of the distress so I could figure out what needed to change. I turned to what I call SOS! 

SOS is the international distress signal and also the acronym for �Stop, Observe, Surrender,� another name for a deeper dive into the koshas. It�s an anywhere, anytime, on or off the mat yoga technique.

Stop: Slow down, pause, and create space to breathe and simply be. This is reminiscent of the mindfulness phrase, �Don�t just do something, sit there.�

Observe: Use the Witness-Wisdom body to: 

1. Notice, sense, and feel all the connection points between your physical body and any surface your body touches. Examine each point. Become aware of texture, pressure, shape, boundaries, and sensation (anamayakosha).
2. Take a moment or two to follow the breath in and out of your body, noticing all four parts of the breath: the inhalation, the slight pause before the exhalation, the exhalation, and the slight pause before the inhalation (pranamayakosha).
3.  Check in with your mind and notice the flow and content of thoughts and the prevalent feeling state/s or emotions (manomayakosha).  

Surrender: This can be the hardest part. To release control, rest, and wait, simply wait for what comes. When an answer comes, and it always does�even if it�s not what we are expecting or hoping for�right action can follow (anandamayakosha). 

I practice this mostly off the mat several times a day when I need to. Great opportunities to do this occur while standing in checkout lines, sitting and waiting for appointments, or lying in bed after lights out and before sleep. After a few days of practice, the answer floated up from my subconscious. Turns out it was my current work and volunteer schedule. It was feeling heavy, mundane, obligatory, and repetitive. I�m sure I knew this at some level but was in denial since dealing with the issue would most likely mean saying no to something I�d happily said yes to and disappointing others, which as a recovering perfectionist (see Yoga Therapy for Perfectionism) is difficult for me to do. The SOS practice helped soften the denial, and open my conscious mind to accept this reality. 

Right action meant simplifying and re-aligning my schedule. Once I accepted that, the irritation, tiredness, and mental fog lifted, and I�ve been able to enjoy my daily journey while in the process of re-organizing my schedule. And my koshas? They are feeling pretty balanced right now. 

Physical Body: Sleep is easy and restful, appetite is good, digestion is balanced, and elimination is regular. My massage therapist noted after my last session, �You must be doing something right. The knots in your back are gone.�

Breath-Energy Body: My breathing is slow, deep, and easy.

Mental-Emotional Body: The mind is calm and peaceful. I see my life working for good.

Wisdom-Witness Body: With the new awareness, I can release the need to distract myself. I still do my jigsaw puzzles but for fun and not as a �check out� activity.

Bliss Body: I feel joy and a sense of being connected and content.

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The Ill Effects of Prolonged Sitting

by Ram

Paul Writing by Camille Pissarro

We live in a hyper-competitive world, where most of us work at stressful, sedentary jobs. In fact, nearly 86 percent of American workers sit all day at their jobs. Furthermore, accumulating evidence suggests that we spend a majority of our time sitting and indulging in sedentary activities. Sedentary activities includes the time spent sitting in an automotive on a long commute, sitting at a desk at work, sitting on the couch after work, watching television, reading, and playing games or surfing the internet. Recent research indicates that on an average, an American adult spends 10-12 hours each day sitting. Notice that sitting is now the norm and physical exercise is considered an intervention program advised by your personal physician to nullify the negative impacts on your health.

Prolonged sitting time considered as one of the major instance of sedentary behavior has emerged as a strong risk factor for various negative health outcomes. Study results have demonstrated associations of prolonged sitting time with premature mortality, chronic diseases such as cardiovascular disease, diabetes, and cancer, metabolic syndrome, and obesity. Those who spend a lot of time sitting have an almost eight-fold increased risk of dying prematurely compared to those who exercise often and are hardly sedentary. Medical experts agree that one of the reasons for a high rate of obesity, high blood pressure, diabetes, cancer, depression and other health issues seen predominantly in younger age individuals is due to prolonged sitting and physical inactivity. For people who engage in prolonged sitting activities, their risk of heart attack is about the same as smoking. The negative consequences are so alarming that medical experts have started referring to the poor health outcome from prolonged sitting as �sitting disease�. 

The ill effects from prolonged sitting are not restricted to the US population alone. In a recent study All-Cause Mortality Attributable to Sitting Time: Analysis of 54 Countries Worldwide in the American Journal of Preventive Medicine, researchers used survey data from 54 countries, analyzing the time spent sitting more than three hours a day along with data on population size, actuarial tables, and overall deaths. More than 60 percent of people worldwide spend more than three hours a day sitting down, and the researchers calculated that sitting time contributed to some 433,000 deaths a year (nearly 3.8% of all-cause mortality) among those 54 countries. 

The above findings agree with another survey of some 220,000 Australian adults Sitting time and all-cause mortality risk in 222 497 Australian adults that was published in the Archives of Internal Medicine. Those who sat for more than eight hours a day had a 15 percent greater risk of dying within three years than those who sat for fewer than four hours a day. The results were more alarming for those who sat for 11 hours or more a day; they had a 40 percent greater risk of early death compared to those who sat for under four hours. This risk sustained even for those who spent some time exercising. Experts now are of the unanimous opinion that even 30 minutes of physical activity is insufficient to neutralize the detrimental effects of 8 hours or more of sitting.

You may wonder why prolonged sitting contributes to negative health outcomes. There are evolutionary and biochemical reasons for this. As humans, our body was simply not designed to sit for prolonged hours. We were evolutionarily designed to "work out,� as evident from our ancestral hunter-gatherers. Hence our body reacts negatively to prolonged sitting. At the cellular level, numerous changes happen all of which trigger the detrimental effects. Prolonged sitting:

• decreases the activity and levels of an enzyme that helps burn fat
• reduces bone mineral density and blocks new bone formation
• reduces the diameter of arteries putting the individual at risk for heart disease
• makes the body insensitive to insulin thus resulting in type-2 diabetes

Additionally, prolonged sitting affects the architecture of the spine, hips and neck as well putting the individual at risk for skeletal fractures. Furthermore, a recent study Television Viewing and Time Spent Sedentary in Relation to Cancer Risk: A Meta-Analysis found that prolonged sitting whether at work or home increases the risk of three cancers namely colon, endometrial and lung. The study also found that high participation in sedentary activities and low participation in physical activities was linked with a 41 percent higher risk of recurrence of colorectal adenomas.

For many of us sitting for eight hours a day at our job is inevitable. This compounded with the extra sitting outside of work is what makes it harmful. Besides, too much sitting is harmful even if you're getting enough exercise. This means you could be meeting the recommended guidelines for a daily exercise but you will still be at higher risk of disease if you sit for long periods each day. So how can one avoid the dreaded effects that come from prolonged sitting? The best solution is to drastically change your lifestyle. While standing for long hours by no means is the answer, most experts recommend a 50:50 sit-stand allowance for optimal health. If your occupation involves sitting for long periods, work at a standing desk. The potential benefits from a standing desk are manifold including: higher productivity, reduced absenteeism, and lower health care costs among many (see A Neutral Posture White Paper). Experts also agree that it is beneficial to interrupt sitting time as often as possible. One way to do this is to move or stretch for at least 10 minutes for every hour of sitting time. 

For those of us who have an active yoga practice, you can either bring in a mini office yoga series (Featured Sequence: Mini Office Yoga Practice) or supplemental yoga with you (Yoga, Your Companion Through the Day). If you need to stretch your back and do not have too much time at hand, you could think of the mini series for the back (Featured Sequence: Low Back Care). Since prolonged sitting is not only having an impact on public health but also has effects on the health span of the individual, it is never too late to make simple changes and maintain a reasonable amount of activity particularly across the middle and later years to avoid early death and serious illness. 

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