Although considered an ancient tradition in Indian culture, yoga therapy falls within the domain of CAM in American society. Public interest in CAM continues to grow; consequently, it behooves healthcare professionals to be informed and to engage their patients in open discussion regarding CAM use.23,24
According to a study drawn from analysis of the 2002 National Household Interview Survey, 24
persons with diabetes use CAM at rates of prevalence equal to those with-out diabetes. Although this study is subject to self-report and recall bias, its findings are clinically important: those with diabetes are more likely to practice prayer than those with-out diabetes, but they are less likely to use herbs, consume vitamins, or practice yoga therapy.24
Current projections of undiagnosed diabetes are quite high, so true patterns of CAM use or yoga practice among those with diabetes are difficult to abstract. One readily discernible trend, however, is the increased experimentation with yoga practice in the United States in recent years. In 2004, findings from a nationwide survey indicated that 7.5% of a nationally representative sample had practiced yoga at some point in their lives, with almost 4% having practiced yoga in the past year; interestingly, 90% of the sample expressed the belief that yoga was very helpful in improving or maintaining health, or both.25
Although the low response rate and low proportion of yoga users necessitate the judicious interpretation of these data, the evidence base for yoga therapy as an efficacious strategy for chronic illness management continues to expand.
The implementation of yoga therapy varies widely. While many researchers conceptualize yoga as a form of PA, others argue that comprehensive yoga, an approach incorporating body postures (asanas
), breathing techniques (pranayamas
), meditation, cleansing, nutrition, attitudinal and behavioral modification, and mental discipline, is more beneficial and loyal to its ancient tenets.19,26–28
Nonetheless, western forms of yoga primarily emphasize components of exercise and stress management.18,19
Yoga therapy has been associated with a multitude of benefits and few adverse effects according to a recent systematic review of the effects of yoga on physiologic and clinical risk factors in adults with diabetes.20
Benefits include significant reductions in fasting and postprandial blood glucose levels, hemoglobin A1c
, total cholesterol and low-density lipoprotein, triglycerides, coronary stenosis, oxidative stress, blood pressure, body weight, waist-to-hip ratio, heart rate, catecholamine levels, need for medication relative to baseline, and psychosocial risk factors.18–20,26–28
Yoga is also associated with decreased weight gain in healthy adults, a matter of significance in the prevention and management of many chronic illnesses, including diabetes.29
Although intervention studies reveal similar positive findings, many have a poor study design, lack an adequate control group, and offer an insufficient description of sampling and statistical analysis techniques.20
Yoga-based therapy is clearly a promising intervention for primary and secondary prevention of diabetes, given the multiple health benefits attributed to the practice of yoga. However, the literature is unclear regarding the most beneficial forms of yoga, the possibility of a dose–response relationship in managing diabetes, and the most labor-effective, cost-effective, and time-effective manner in which to train patients. Moreover, no studies were identified that measured factors contributing to the maintenance of yoga practice over time. An exploration of the social determinants of PA in general will provide a logical basis for understanding factors that may contribute to yoga practice as well.