Bikram Yoga May Improve Depression

A recent study published in the journal of Clinical Psychiatry : 10.4088/JCP.22m14621 suggests that sessions of heated Bikram yoga reduce the symptoms of depression.

A randomized controlled clinical trial of adults with moderate-to-severe depression was completed with the study subjects attending twice weekly sessions over an 8 week period. Those who participated in heated yoga sessions experienced significant reductions in depressive symptoms compared with a control group.

The researchers enrolled 80 participants for the study. Clinical measurements were done which classified those who qualified for the study as having moderate to severe depression. They used a psychiatric test measurement called the IDS-CR score (Inventory of Depressive Symptomatology-Clinician Rated). They gave each  participant an IDS-CR score prior to and after completion of their participation in the study.

The study participants were given exit interviews at the completion of the study and rated the heated yoga sessions in positive terms and were shown to have manifested improvement in depression symptoms seen as a reduction in their ICD-CR scores.

The study review of participants’ experiences uncovered that 59.3% of yoga participants had a 50% or greater decrease in symptoms. Furthermore 44% of the participants’ scores were lowered enough that their depression was considered in remission. This research was done by investigators at Massachusetts General Hospital, and their conclusion was that  heated yoga could be a viable treatment option for patients with depression. Although the instructions given to the study subjects was to attend the 90 minute heated yoga sessions twice per week, many of the participants did not keep up with that schedule.  On the average study participants averaged 10.3 sessions over the 8 week period. This provided researchers with enough information to say that for many people the twice per week regimen may not be necessary for improvement of depression, and that even a once per week regimen may be enough to provide a meaningful improvement.

The study’s lead author was Maren Nyer, PhD., director of Yoga Studies at the Depression Clinical and Research Program at Massachusetts General Hospital. He says,”Yoga and heat-based interventions could potentially change the course for treatment for patients with depression by providing a non-medication-based approach with additional physical benefits as a bonus.We are currently developing new studies with the goal of determining the specific contributions of each element — heat and yoga — to the clinical effects we have observed in depression.”

Participants generally told the investigators in their exit interviews that the heated yoga sessions were a positive experience, and there were no serious side effects associated with the sessions. Another senior author and researcher David Mischoulon, MD, PhD, Director, Depression Clinical and Research Program at Massachusetts General Hospital said, “Future research is needed to compare heated to non heated yoga for depression to explore whether heat has benefits over and above that of yoga for the treatment of depression, especially given the promising evidence for whole body hyperthermia as a treatment for major depressive disorder.”

The NIH reviewed the Health Effects of Bikram Yoga :

Bikram yoga is a style of hatha yoga utilizing  a set of asanas (postures)  performed to an instructional dialogue in a heated environment (40.6°C, 40% humidity). It has been shown to improve lower body strength, lower and upper body range of motion, and balance in healthy adults. There are research reports that Bikram yoga may improve glucose tolerance, bone mineral density, blood lipid profile, arterial stiffness, mindfulness, and perceived stress.

Bikram yoga is a standardized system of hatha yoga developed by Choudhury []. The three factors together that distinguish Bikram yoga from other forms of hatha yoga are the heated environment,  instructional dialogue, a set sequence of 26 asanas and two breathing exercises.  Each 90 min session begins with standing pranayama (deep breathing) followed by the standing asanas (45–50 min). The standing sequence is followed by a 2 min savasana supine relaxation, and a sequence of floor asanas for  35–40 min. A 20-second savasana is taken between each asana in the floor series. The session is completed with a seated breathing exercise (kapalabhati) using quick, strong exhalations, and a final savasana. Dr.  Choudhury hypothesizes that the heated environment helps warm and prepare the body for movement and assists body detoxification.

A number of studies have assessed the acute and chronic  effects of Bikram yoga practice in apparently healthy adults [] . They measured parameters of physical fitness, cardiovascular disease risk, quality of sleep, bone density and psychological health. Better readings in these parameters  are associated with better health status and a lower risk of chronic diseases, disability, and mortality [].

In order to assess physical fitness they measured the following : muscular endurance, muscular strength, cardiovascular fitness, flexibility, and body composition. They further looked at  six skill-related factors:  speed, power, agility, balance, reaction time, and coordination) [].

Four studies to date have evaluated the effect of Bikram yoga training on measures of health- and/or skill-related physical fitness []. In one study they measured the effects on 21 healthy adults of an 8-week Bikram yoga program of 3 sessions per week. They measured flexibility, muscular strength, body composition,  steadiness (neuromuscular control), cardiorespiratory fitness (VO2max), and balance. After completing the 8-week program, subjects had significantly increased lower body range of motion,they had significantly improved balance, and significantly improved isometric dead-lift strength.  In another study also using an 8 week Bikram yoga program, they  reported significant improvements in single-leg balance and improved upper body range of motion []. These improvements in range of motion and balance confirmed other studies showing similar results [].

The asanas that train trunk and hamstring flexibility last from 10 to 60 seconds, and improve passive and active range of motion []. Locally applied moist heat increases range of motion of the muscles []. Along with the heated environment of Bikram yoga (added to physical activity) may impart a similar effect on  musculoskeletal tissue. The asanas that  involve the lower body strength improves lower body strength and []. Improvements in flexibility, strength, and balance have a tremendous impact on quality of life, in the older population, because these aspects of physical fitness decline with age, and are associated with risk of falls and injury[].

2.4. Bone Mineral Density Maintaining bone density throughout life is essential since  falls-related fractures are significantly greater with osteoporosis which is  defined by its  loss of bone density.  For those who are unable to engage in high impact weight bearing exercise such as running, yoga may maintain bone density in some populations [60]. Since Bikram yoga has been shown to improve lower limb strength and single-leg balance it may reduce the risk of falls and fractures []. A 5-year study assessing bone mineral density in  nine female Bikram yoga teachers showed increased Bone mineral density at the femoral neck , the hip, and lumbar spine.

2.6. Psychological Adaptations

Chronic stress is known to be associated with a number of chronic health conditions such as cardiovascular disease. Stress contributes to systemic inflammation, an underlying cause of disease in general[]. It has been hypothesized that hatha yoga practice may reduce  the inflammatory response, which would lead to a reduction in stress- and inflammation-related illnesses [].

Another study was performed to assess the  effectiveness of 8 weeks of Bikram yoga-3 classes per week- on mindfulness, perceived stress, and physical fitness using 51 apparently healthy men and women []. It showed that perceived stress significantly improved. Like the practice of Tai Chi, Hatha yoga offers a “meditation through movement” method [], which contributes to increased mindfulness and reduction in perceived stress. Hatha yoga incorporates physical activity and  relaxation in the same class. Participants are encouraged to keep the mind present with the movement of the breath and the body in different asanas. These qualities encourage mindfulness and reduce perceived stress.

These studies provide a starting point for understanding Bikram yoga’s relationship to measures of  health and present opportunities for more  research examining stress reduction and associated health risks.  Hatha yoga is a holistic practice making its assessment hard to quantify and compare to other forms of exercise []. More research is needed  to determine whether or not Bikram yoga  is an effective intervention for a wide variety of health concerns that it may indeed be able to benefit.

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