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CancerLynx - we prowl the net
June 5, 2000

Yoga for HIV/Aids, Cancer and other Life Challenges
Jnani Chapman, RN, BSN, CMT

Waz Thomas was teaching yoga to people with cancer at Commonweal's week long residential retreat program along the northern California coast when he tested HIV Positive. Now, 13 years later he is still teaching yoga adapted to the special needs of people with cancer, many of whom are living with complicated disease and treatment scenarios. In those years, Waz, himself, has had one hospitalization for bacterial pneumonia and an occasional chronic sinus or ear infection, but overall he continues to look and feel great.

While yoga has been observed and experienced for more than 3,000 years to help maintain and restore health, it has only been recently introduced in the West. Most people associate yoga with exercise and most yoga classes focus the entire time on physical movement. But yoga is in many ways opposite of exercise and some of the non-movement-oriented practices of yoga can have a profound effect on the physical body.

In exercise we engage in a rhythmic repetitive muscular movement. The brain responds by telling the muscle fibers to shorten and tighten. Muscle fatigue with exercise may bring us a satisfying feeling and tell us we got a good work-out. In contrast, fatigue in the body in yoga stretches is an indication that we may be doing something wrong. Sore muscles are a sign that we overdid it in stretching or holding a pose. The goal in hatha yoga ( the name for the postures and stretches ) is to keep the muscles relaxed in movement so that the muscle fibers actually elongate. The resulting increase in range-of-motion and flexibility is accompanied by improved sense of well-being.

The yoga practitioner engages the body in a stretch extending and elongating as much as comfortable into a pose, not as much as possible. This distinction is important because nowadays many yoga studios are teaching a more aerobic, almost aggressive style of hatha that is actually more like exercise than yoga. These classes are popular and provide a good workout, but they may better be thought of as a combination of yoga and exercise, rather than a classical yoga session. Such a class can substitute as exercise for people who want to cross train or expand their exercise options. One can expect the class to improve strength, muscle tone, cardiovascular tone and provide some increase in flexibility. For people who are tying to restore and maintain health, however, this modified form of yoga exercise may actually perpetuate a depletion syndrome.

How is this so? Exercise stresses muscle and, while this can be useful and helpful, if one over-does it in exercise it can initiate a stress response in the body. They are consuming oxygen that the body is not producing for them (as it is when we exercise). The stress response shunts blood away from the digestive organs and creates a cascade of biochemical and neurological triggers which tax multiple systems including the immune system. Our skeletal muscles are well endowed with capillary beds--a rich, intricate network of blood vessels which provides the oxygen needed for the muscles to work. Overdoing exercise may induce a competition for oxygen as the stress response increases metabolism, increasing the body's need for oxygen if muscle fibers stay tight during rest. The engaged muscles will continue to receive the oxygen they need, while other parts of the body like internal organs, the endocrine and immune systems, may suffer.

Hatha yoga (The physical postures and movements of yoga) focuses at its core on flexibility of the spine: forward bends balance backward-bending poses, left twists balance twists to the right. There are even inverted positions to counter-balance gravity. In the Sanskrit language of ancient India tha means moon and ha means sun. The two together ha-tha are indicating the balance of opposites (night and day, yin and yang). The spine is integral for physical balance. Self-awareness is integral for emotional balance. The attitude one brings to hatha practices is as important as the practice itself. One could say if exercise is yang, yoga is yin: Exercise is physical effort, but in yoga the effort is primarily mental. On a treadmill the mind can be a million miles away while the person achieves a physical benefit but in yoga the mind must be present, attentive in the moment, noticing what is happening and aware of how it feels.

The best definition of yoga I have ever heard comes from TKV Desikachar, considered by many to be the father of yoga therapy, who said, Awareness, breath and movement--that is yoga!

It is often said that awareness is the first step in change. If we have things we want to change physically, mentally, emotionally and even in the amount of available daily energy and stamina-our willingness to see and accept them as they are may be a key to enabling change, movement and growth. Hatha yoga practice gives us time to look at ourselves, and that time spent will be fruitful to the extent that we are genuinely willing to explore and discover our limits. As you stretch and breathe be aware of any competitive thoughts or judgments. Don't let them guide your actions. Let yourself relax into each stretch and stay relaxed as you move and breathe.

When Waz Thomas teaches yoga at Commonweal he is adapting it to meet the needs of each student. Each class usually includes hatha postures and stretches, breathing practices, a guided deep relaxation and a period of silent meditation. He says that these practices are integrated into his daily life informing his actions moment by moment. In fact, Waz says, "I feel that my health is better than most of my friends who are not dealing with AIDS", and he credits yoga for its part in keeping him relatively symptom-free. May the practices of yoga continue to serve the needs of persons with HIV/Aids, cancer and other life threatening conditions, helping people to sustain and regain functional status, quality of life and feelings of well-being during difficult times.

The Extended Exhalation Breath
Here is a breathing practice that also will help develop awareness. The benefits that consciously controlled breathing can provide are more researched than most other aspects of yoga (with the exception of meditation). Please try this extended exhalation breathe and let yourself experience what it can do. Begin by watching the natural breath without attempting to control it. Let the breath come and go (as it was doing before you started to think about it). As it flows notice what areas of the body are involved automatically with breathing. Does the abdomen expand and contract as the breath comes and goes? Do the sides of the rib cage move? What about the shoulders? What about the chest? Try to let the muscles of the trunk relax so that they can move easily and effortlessly. When you can achieve and maintain this relaxed state you are ready to begin consciously controlling the breath.

The goal is to control the exhalation--to slow it down--to extend it until it is twice as long in duration as the inbreath. Let the breath flow out evenly and steadily for four to six seconds and let the inbreath take half that time, two-three seconds. In the beginning it may not even be possible to get to a 2:1 ratio. That's ok. Work toward a twice-as-long exhale comfortably letting the practice build with time. How long you chose to exhale should be determined by how long it can be done easefully and comfortably. Do not extend the exhalation for longer than twice the inhale. Pay attention to how each part of the body feels during the practice. If you notice tension or tightness this is a signal that you are trying too hard. Some people begin the extended exhalation breathing practice able to exhale evenly for four-six seconds and even able to let the inhalation be full and efficient in two or three seconds. Others may find that inhaling for one or two seconds is okay but the exhale is gone in three or four seconds. Accept whatever ratio feels natural for you. Let the practice be rhythmic and steady. Let yourself relax in a comfortable position while practicing this technique.

When you succeed in finding a comfortable 2:1 ratio begin extending the length of time you practice each session. As the practice develops people find that the lung capacity naturally improves with time. You may notice that doing 2 seconds in and 4 seconds out will grow to 3 second in with 5 or 6 seconds out, and eventually to longer durations that maintain the 1:2 ratio. Try it initially for two or three minutes. Always stop if there is any lightheadedness or dizziness. This is a signal of fatigue in the body. In this situation it is better to engage in the practice of watching the natural breath. Some people do the extended exhalation breath for five or 10 minutes twice a day. Other people choose it as a focus for meditation and may practice from one-half to one hour each day.

The CAT/COW Pose
A wonderful yoga stretch that has been used widely in physical therapy is commonly known as Cat/Cow. Cat/Cow is an awareness practice and a movement sequence done on hands and knees. The purpose is to experience the range of motion currently available as we move the pelvis in opposite directions; first, by tucking the tailbone in to round the back at one end of the movement spectrum and then by extending the tail bone to flatten the back at the other end of the spectrum. Remember to be gentle and easy. Do not push or force the body.

Please be on a padded mat or rug to avoid hurting the knees. Relax into the movements, moving and breathing evenly and comfortably. Place each knee directly below the center of the hip joint so that the thigh is perpendicular to the floor and place wrists or fists directly below the center of the shoulder joint so that the arm is perpendicular to the floor without any bend at the elbows. Keep your neck in line with the spine so that you don't allow the head to drop.
Slowly and evenly

-- exhale as you round the back by tucking the tailbone in/under. (The image apparently of a Halloween cat hissing on a fence). You are simultaneously pointing the waist up toward the ceiling by drawing the belly in and up and curling the chin in toward the chest to help contract lungs as you exhale. When you are ready to

-- inhale: flatten the back by elongating and extending the tailbone as you lift the neck in line with the spine, opening and expanding the chest for the length of the inhale. This is the cow in its field, who is is extending the tail bone in one direction and elongating the neck so the crown of the head extends in the other. Then, continue to

-- breathe in and out coordinating each breath to a direction of movement. As the back curls and rounds from head to tail for the cat you are contracting the lungs and letting the air flow out evenly and steadily. Then as the spine elongates from the crown of the head through to tip of the tail for the cow you are inhaling long and deep letting the breath open and expand the chest. Exhale as you curl the tailbone in and under pressing it forward toward the chin as it curls in toward the chest; then, inhale as you extend the tailbone back to elongate the spine as the chin extends to let the crown of the head elongate.

Cat/Cow is commonly used for back problems to help the spine and pelvis restore range of motion and to help back muscles gain strength. Try this practice first for three-five minutes and see how you feel. If it feels good and seems to sustain then continue the practice regularly once or twice a day.

Yoga Research Note The list is long and includes asthma, arthritis, anxiety and depression, headache, backache, hypertension, heart disease, diabetes, pain management and insomnia, as well as alcohol and drug abuse. Much of this research was done in India and Europe. Yoga studies in the United States are limited. Most studies include yoga as one of several modalities of comprehensive lifestyle management programs.

The research done by Dean Ornish, M.D. and his colleagues used yoga as stress management for heart patients along with vegetarian diet, exercise and group support. The people in his study who practiced at least one hour of yoga a day achieved reversal of coronary artery blockages and people who practiced more than one hour of yoga a day achieved even greater reversals.

Dean Ornish's The Preventive Medicine Research Institute in Sausalito, CA contracts with hospitals around the country to offer the Ornish program to people with coronary artery disease. They are also presently conducting research on the effects of Dr. Ornish's program for men with prostate cancer (phone: 415-332-2525; fax: 415-332-5730)

Another good example is the research of Jon Kabat-Zinn, PhD at the University of Massachusetts Medical Center Stress Reduction Clinic in Worcester, MA. His study showed that yoga stretches and meditation were useful for stress management and pain control. The program, called Mindfulness-based Stress Reduction, is offered in many hospitals around the country (phone, 508-856-2656; fax, 508-856-1977).

Of Interest:
Physical Medicine Approaches To Pain Relief
A Restorative Yoga Therapy for Breast Health and Breast Cancer
Three Keys to Manage Breast Cancer-Related Lymphedema

Jnani Chapman, RN, BSN, CMT Osher Center for Integrative Medicine San Francisco, CA 94115 415-353-7718

Commonweal PO Box 316 Bolinas, CA 94924 415-868-0970

See also Yoga In Illness and Health by Jnani Chapman

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