Yoga, though side-lined in the past, has become the lingua-franca of every household especially as a morning routine. This knowledge stems primarily from culture and secondarily from affluence – Yoga as in exercise.However, Yoga seems to have answers for everyone who have “sought” for it, be it the opulent seeking to get their caloric burn for the day, be it the one in search of “bhakti” and Samadhi, or be it the followers of science seeking to explore Yoga in hundreds of erudite and pragmatic dimensions.
Worldwide perspectives of YogaResearch
Based on the results and response of clinical studies conducted on different yogic techniques in a large group of patients, concepts like pranayama, asanas, and yogic dietary rules are now being considered as mainstay therapy for various ailments. Diseases like anxiety and depression, bipolar disorder, obsessive-compulsive disorder (OCD), sleep disorder, cholesterol imbalance, diabetes, hypertension, and thyroid disorders are primarily being considered for treatment through yogic guidelines. Provided the safety (compared to chemicals), approachability, and initiative it provides these yogic principles and approaches are here for the long run.
In India Yoga is being studied academically in about 56 universities and institutions. These courses are shaped from the very basics to Yoga as a form of scientific study. SVYASA, one of the pioneer universities in Yoga academics and research, has 19 different courses which range from Yoga instructor course, Yoga journalism to Ph.D. in Yoga. Thousands of other traditional Yogacenters, registered/ unregistered are providing traditional practices of Yoga in different states.
Accordingly, 23 large scale interventional clinical trials have been completed recently as per the official website of the clinical trial registry of India (http://ctri.nic.in/Clinicaltrials/login.php). 12 clinical studies are on-going and few observational studies are also on-track of being approved. The sheer number is quite high when also considering allying treatment systems like Ayurveda, Naturopathy or conventional medical system which also have been conducting Yogaresearches. Research on common ailments such as type 2 DM, hypertension, cardiac complications, neurological disorders, and psychiatric problems, bronchial asthma, epilepsy, polycystic ovarian syndrome, dyslipidaemias, metabolic syndrome, obesity, depression, and psoriatic skin disease are being extensively conducted.
In the US 36 accredited centers for Yoga therapy are currently operational, half that number are functioning in Canada. According to the United States national database system (https://clinicaltrials.gov/), a total of 84 clinical studies are being conducted using Yoga therapy as an intervention, and a total of 225 studies have been recently completed. The majority of diseases being studied on using Yoga therapy as intervention are predominantly psycho-neurological in nature - migraine, depression, anxiety, chronic pain, fatigue - and secondarily Yoga therapy for chronic diseases like heart disease, osteoporosis, cancers, Parkinson’s disease, COPD, etc. are also gaining traction as researchable materials in scientific communities. Almost all institutions conducting these studies are well established medical centers for contemporary practice, not particularly for Yoga. But experts are working in collaborations with experienced yogis as such no stone is left unturned (the US way).
The enthusiasm that Yoga holds the key to most of the human suffering has been received with optimism worldwide and the world seeking for a more approachable and holistic way of healing has embraced Yoga with open-arms. Pharmaceuticals create secondary effects which might sometimes be unwarranted or even life-threatening sometimes and from this idea builds towards the recent trend towards non-interventional approaches to healing.
The statistics provided above are definitely insufficient to meet the requirement of scientific evidence in order to establish protocols for treatment – as a replacement for pharmaceutics – however, it is a symbol of enthusiasm and interest of the world towards a very eastern concept.
Shortcoming and challenges in YogaResearch:
Despite great interest and involvement in Yogaresearch worldwide, it is not yet oriented towards addressing public health demand. Every research – not only pertaining to Yoga – should be able to answer some few basic questions: is it generalizable? Is it standardisable? What amount of money will be worth the investment?
Key stakeholders of Yoga like end users, prescribers and payers should have sufficient scientific knowledge to answer those questions. Lack of economic resources and insufficient streamlining are definitely some of the problems that Yoga is facing, but the major pitfall lies in understanding and pursuing yogic concepts itself and having a structured uniformed approach to Yoga research.
Therapeutics being researched is mostly based on asanas (colloquially poses), but the basic principle of Yoga was initially formulated such that takes us on the journey from physical planes of the body towards a deeply spiritual one. In mentioning Yoga Patanjali guides us through Ashtanga (eight dimensional) Yoga, which includes Yama, Niyama, Asana, Pranayama, Pratyahara, Dharana,Dhyana and Samadhi. Practicing asanas resembles physical exercise Yoga – it does not incorporate the sentiments of Yoga. In this scenario, controlled groups should also be provided training on what following the guidelines of Yoga entails.
Some of these studies have hidden methodological problems. To give a brief example, 72% of studies do not report on duration and detail about home practice, also a history of previous practices is generally ignored, to counter this fact most studies suggest an average of 60-90 minutes of practice.
Practice in Nepal:
Throughout the country, a total of 32 Yogacenters are functioning which provides basic level Yoga training and certifies the participants, most of them are based on Kathmandu and Pokhara. None of these institutes conducts academic courses. Only Nepal Sanskrit University has been conducting diploma in Yoga, recently Tribhuvan University has also taken initiatives. From government level, national Ayurveda Research and Training Center has incorporated Yoga and Ayurveda, a similar approach has been made by Patanjali Ayurveda Medical College and ResearchCenter recently. Till date, no journal has been published on Yoga. Few studies might be conducted by medical colleges and hospital incorporating Yoga interventions, but because of lack of national database, information is not easily approachable from the public domain.
Way to make YogaResearch more effective:
Yogaresearch should be able to unwind all the possible aspects of yogic science by exploring every aspect of human life. Firstly, well-defined research methodology is required which not only should be aligned to yogic principles but made to be as such which is recognizable by the scientific community. The current issues such as lack of clear definition, wide variation in the interventional period, lack of data on comparative effectiveness between Yoga variables and confounding and selection biases should be considered, recognized and remedied. In order to increase the social impact, researches should not be confined only to therapeutic effects but also to health governance, health economics, health tourism, and spirituality.
Being a land of yogis, hundreds of Yoga trainers and thousands of “lay” people are practicing Yoga regularly and aspirants are increasing day by day. But, in scientific aspects, Nepal has not been able to give any evidence to the world by conducting research activities; neither initiative towards these aspirations is being undertaken. Firstly, a national database should be designed and executed by government level in order to provide a basic platform to register any clinical study. By taking initiatives right now, Nepal as a country of raw materials and possibilities can easily be changed into a land of scientific yogis.
- Author is an Ayurveda doctor pursuing Clinical Research in Jain University, Bangalore, India.