12 Minutes of Yoga for Bone Health
By JANE E. BRODY NY Times article DECEMBER 21, 2015 5:45 AM December 21, 2015
Yoga enthusiasts link the
practice to a long list of health benefits, including greater flexibility and
range of motion, stronger muscles, better posture and balance, reduced
emotional and physical stress, and increased self-awareness and self-esteem.
But definitively proving these
benefits is challenging, requiring years of costly research. A pharmaceutical
company is unlikely to fund a study that doesn’t involve a drug, and in any
event, the research requires a large group of volunteers tracked over a very
long time.
The subjects must provide health
measurements at the outset, learn the proper poses, continue to do them
regularly for years and be regularly evaluated.
No one knows these challenges
better than Dr. Loren M. Fishman, a physiatrist at Columbia University who
specializes in rehabilitative medicine. For years, he has been gathering
evidence on yoga and bone health, hoping to determine whether yoga might be an
effective therapy for osteoporosis.
The idea is not widely accepted
in the medical community, but then, researchers know comparatively little about
complementary medicine in general. So in 2005, Dr. Fishman began a small pilot study of yoga moves that turned up some
encouraging results. Eleven practitioners had increased bone density in their
spine and hips, he reported in 2009, compared with seven controls who did not
practice yoga.
Knowing that more than 700,000
spinal fractures and more than 300,000 hip fractures occur annually in the
United States, Dr. Fishman hoped that similar findings from a much larger study
might convince doctors that this low-cost and less dangerous alternative to
bone-loss drugs is worth pursuing.
Those medications can produce
adverse side effects like gastrointestinal distress and fractures of the femur.
Indeed, a recent study published in Clinical Interventions in Aging found that
among 126,188 women found to have osteoporosis, all of whom had Medicare Part D
drug coverage, only 28 percent started bone drug therapy within a year of
diagnosis.
Many of those who avoided drugs
were trying to avoid gastrointestinal problems.
On the other hand, yoga’s “side
effects,” Dr. Fishman and colleagues wrote recently, “include better posture,
improved balance, enhanced coordination, greater range of motion, higher
strength, reduced levels of anxiety and better gait.”
Weight-bearing activity is often
recommended to patients with bone loss, and Dr. Fishman argues that certain
yoga positions fit the bill.
“Yoga puts more pressure on bone
than gravity does,” he said in an interview. “By opposing one group of muscles
against another, it stimulates osteocytes, the bone-making cells.”
Most experts argue that it’s
difficult, perhaps impossible, for adults to gain significant bone mass.
Undeterred, Dr. Fishman invested a chunk of his own money and with three
collaborators — Yi-Hsueh Lu of The Rockefeller University, Bernard Rosner of
Brigham and Women’s Hospital, and Dr. Gregory Chang of New York University —
solicited volunteers worldwide via the Internet for a follow-up to his small
pilot study.
Of the 741 people who joined his
experiment from 2005 to 2015, 227 (202 of them women) followed through with
doing the 12 assigned yoga poses daily or at least every other day. The average
age of the 227 participants upon joining the study was 68, and 83 percent had
osteoporosis or its precursor, osteopenia.
The 12 poses, by their English
names, were tree, triangle, warrior II, side-angle, twisted triangle, locust,
bridge, supine hand-to-foot I, supine hand-to-foot II, straight-legged twist,
bent-knee twist and corpse pose. Each pose was held for 30 seconds. The daily
regimen, once learned, took 12 minutes to complete.
The researchers collected data
at the start of the study on the participants’ bone density measurements, blood
and urine chemistry and X-rays of their spines and hips. They were each given a
DVD of the 12 yoga poses used in the pilot study and an online program in which
to record what they did and how often.
A decade after the start of the
study, bone density measurements were again taken and emailed to the
researchers; many participants also had repeat X-rays done. The findings,
as reported last month in Topics of Geriatric Rehabilitation,
showed improved bone density in the spine and femur of the 227 participants who
were moderately or fully compliant with the assigned yoga exercises.
Improvements were seen in bone
density in the hip as well, but they were not statistically significant.
Before the study, the
participants had had 109 fractures, reported by them or found on X-rays.
At the time the study was
submitted for publication, “with more than 90,000 hours of yoga practiced
largely by people with osteoporosis or osteopenia, there have been no reported
or X-ray detected fractures or serious injuries of any kind related to the
practice of yoga in any of the 741 participants,” Dr. Fishman and his
colleagues wrote.
“Yoga looks like it’s safe, even
for people who have suffered significant bone loss,” Dr. Fishman said in an
interview.
Furthermore, a special study of
bone quality done on 18 of the participants showed that they had “better
internal support of their bones, which is not measured by a bone density scan
but is important to resisting fractures,” Dr. Fishman said.
The study has many limitations,
including the use of self-selected volunteers and the lack of a control group.
But all told, the team concluded, the results may lend support to Dr. Fishman’s
long-held belief that yoga can help reverse bone loss.
Even if bone density did not
increase, improvements in posture and balance that can accrue from the practice
of yoga can be protective, Dr. Fishman said.
“Spinal fractures can result from poor posture, and
there’s no medication for that, but yoga is helpful,” he said.
In addition, “Yoga is good for range of motion, strength,
coordination and reduced anxiety,” he said, “all of which contribute to the
ability to stay upright and not fall. If you don’t fall, you greatly reduce
your risk of a serious fracture.”
“Illuminated emancipation, freedom, unalloyed and untainted bliss await you, but you have to choose to embark on the Inward Journey to discover it.” BKS Iyengar
