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Narrator: The U.S. Department of Health and Human Services,
National Institutes of Health,
and the National Center for Complementary and Alternative Medicine 
present the following video, 
"Scientific Results: Yoga for Health and Well-being".
The video features an introduction by Dr. Josephine Briggs,
Director of the National Center for
Complementary and Alternative Medicine,
or NCCAM,
and interviews with Dr. George Salem and Dr. Karen Sherman, 
researchers who are studying yoga.
Following the interviews with Drs. Salem and Sherman
are five brief tips for people interested in practicing yoga.
The tips are accompanied by video footage of certified yoga
instructors
Yasmine Kloth and John Acton performing yoga techniques
in an outdoor setting.
Dr. Briggs speaks from an office
at the National Institutes of Health in Bethesda, Maryland.
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Hello, I am Josie Briggs, director of the
National Center for Complementary and Alternative Medicine,
or NCCAM.
NCCAM is one of 27 institutes and centers that make up
the National Institutes of Health,
the government's medical research agency.
Our mission at NCCAM is to define,
through rigorous scientific investigation,
the usefulness and safety
of complementary
and alternative medicine interventions
and their role in improving health and health care.
In this video, we give you
an introduction to yoga,
a mind-body practice
that has its origins in ancient Indian philosophy.
Yoga is increasingly being integrated
into our health care system.
At NCCAM we are particularly
interested in how health care
providers are using yoga to improve
the health of their patients.
For example, to prevent
falls in older adults,
or to address persistent conditions
such as chronic low back pain.
This video will introduce you to
some of the research that we are
supporting to better understand
the health benefits of yoga.
We will highlight two of our
researchers who are studying yoga,
Dr. George Salem and
Dr. Karen Sherman.
Dr. Salem is at the
University of Southern California.
He is using innovative technology to examine how older people
use their muscles and joints in certain yoga postures.
As a researcher with a primary
interest in the science of exercise,
Dr. Salem focuses on the mechanics
of the musculoskeletal system.
How our bodies move.
He will talk about why he chose
to study yoga and some of the
challenges in studying
this mind-body practice.
The second person you are going to hear from is Dr. Karen Sherman
who conducts research at Group Health Cooperative in Seattle.
Dr. Sherman has found yoga to be beneficial
for people with low-back pain.
In this video, she talks about low-back pain
and the challenges of designing a rigorous yoga study
that will explore the promise of this intervention.
I hope you enjoy this presentation
and that it piques your interest in
learning more about integrative
health practices like yoga.
If you are
considering practicing yoga,
I encourage you to talk to
your health care provider.
Ask about the physical demands of the type of yoga
you are interested in and learn more
about what research has been done on this practice.
Regardless of the type of integrative health practice
you are considering,
share information
about what you do for your health
with your health care providers.
It will help ensure
safe and coordinated care.
Thank you for your interest,
and I wish you good health.
Narrator: NCCAM has provided this video for your information only. 
It is not intended to constitute or substitute for medical advice
or for personal exercise instruction.
We encourage you to discuss all questions and decisions
about medical care or treatment with your health care provider
before beginning any new exercise program,
including the program featured in this video.
Any reference to or appearance of any product, service, or therapy
in this video is not intended as an express or implied endorsement
by NCCAM or the Federal Government.
Drs. Salem and Sherman were interviewed in their research labs
in Los Angeles, California and Seattle, Washington.
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My name is George Salem.
I'm an associate professor and researcher
in the division of biokinesiology and physical therapy
here at the University of Southern California.
So, I am interested in exercise.
I have been studying exercise for the past 30 years and using
biomechanics force platforms, high speed cameras to understand
how exercise targets the musculoskeletal system.
So, our primary objective in the current study,
"Yoga Empowers Seniors Study",
is to
provide information for instructors
who are going to be
designing programs for seniors.
However, this information is also going to be very useful
for the clinician or therapist so that
they can design individualized programs
for their patients.
Yes, we believe yoga is good and it has its place
along with other forms of exercise, but what we want to do
is make sure that the programs are tailored for the senior
who may be participating in yoga for the very first time.
To my knowledge, nobody has
quantified the biomechanics,
the forces, the muscle recruitment patterns, the joint movements
or torques that are created during yoga in healthy seniors.
It's very innovative,
it's very different.
It's, it's creative and
that's what makes it exciting.
We recreate their poses and show
them what their skeletal system
would look like.
Skeletons actually performing the yoga poses--asanas--
and they get to see their muscles light up and do different things.
It's very exciting
for our participants.
The challenge is that I we work
within a laboratory with lights,
with force plates.
Our subjects have
to be instrumented.
We put reflective
balls on their joints.
We put wires across their muscles, they have tape
and all kinds of electronics associated with them.
And yet we need them to feel comfortable
and so we always do our studies with a yoga instructor present.
We always take them
through an actual yoga program.
They are not just standing there posing
but rather they are performing yoga.
They have a warm up period.
They have a cool down period, we incorporate breathing
and concentration, meditation techniques as well.
We do have some
preliminary results and what,
what's fascinating and, and neat
about the project is that many of
those results were not intuitive.
Poses we thought were targeting certain muscle groups
actually are targeting completely different muscle groups.
Poses we thought were relatively safe
are actually generating rather large loads and joint torques
at joints in which older adults can get into trouble.
So, if I could I'd like to give you an example of a pose
which we thought was going to be doing one thing
but now we've learned it's doing something very different.
And that would or those poses
would be the warrior poses.
And the warrior poses, it's often thought that these
are very important poses for increasing balance in,
in individuals and in fact it
intuitively that makes sense.
You're in a position
with an extended base.
Your legs are spread far apart.
We call that an abducted position.
And we always hypothesized
that that pose would be targeting the outer muscles of the thighs
the gluteus medius muscle or the abductor muscles.
We found that as opposed to
targeting the abductor muscles,
they were actually targeting the inner muscles of the thigh
the adductor muscles.
A better pose for that
might be the tree pose,
for example, which we know from our biomechanical investigation
does target the hip abductors.
It's likely to increase one's balance control
because those hip abductors are important for balance.
One of the things we're learning
is that some of these poses are really not intuitive.
This information then will ultimately be disseminated
perhaps in a book or perhaps online,
and instructors can then go and bring
down then take this information
and design a program that is going to be safe and effective.
As we analyze our current results we will be expanding our studies
to include other groups of individuals,
both healthy individuals and those with disabilities.
As yoga participation has
increased in recent years though,
we understand that this is an area
that really is under-researched,
and in discussing and
working with my colleague at UCLA,
Gail Greendale, we
really decided that,
hey, here is an opportunity for us
to use these very unique tools,
these, these very tech, high tech tools to better understand
what yoga is actually doing,
how it's targeting the physiology the
biological processes of our body.
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My name is Karen Sherman,
and I'm a senior scientific investigator
at Group Health Research Institute.
I started researching yoga because
I actually was quite interested in
complementary medicine
treatments for back pain.
Back pain, as you know, is the
number one reason why people search
outside of the conventional
med, medical area for some relief,
and at the time that I began
my work here at Group Health,
there was actually no formal studies
that had been published on yoga.
No solid research out
there at that time,
and I thought, wow, this is
natural kind of thing to do,
so I jumped on it.
So, we started our first yoga study was funded in 2005
and the first thing that we did before
we even did the clinical trial
is we had to sort of design it.
So, one of the things that we had to ask ourselves is
what should the yoga intervention look like?
And we chose to focus on postures and breathing
with some of the relaxation elements explicitly added.
We chose to use a style
of yoga called vini yoga.
The idea of vini yoga being that
you adapt the posture to the person.
So, how are you going
to design your study?
What are you going to compare it to?
We said there's really two
things we're very interested in.
One is, "how does it
compare to usual care?"
That is to say what
people would normally do?
And we augmented our usual
care with a self-care book.
And that was sort of a
basic standard of comparison.
And then we were just curious,
how is yoga different from sort of conventional exercise?
I have to say that back pain researchers often find
that nothing works so I was actually surprised that yoga did work.
It was clearly superior to usual care at all time points
and it was better than the exercise at a couple of time points.
Not enormously better
but statistically significant and intriguing.
We've moved on to do two things.
One is to try to confirm those
results in a much larger population.
Secondly, to try to
understand, what's really going on?
How is yoga working?
Is it simply lots of stretching and strengthening
or are there other elements that are really important
the relaxation kind of stress reduction sorts of things.
In thinking about how this research is actually going to help
the clinician and the patient,
I do think research is very important for people with back pain.
There are over a hundred
treatments for back pain out there,
most of them have not been tested and what's the poor clinician
or what's the poor patient to do?
Caring for people with low-back pain is actually quite challenging
for the conventional physician.
Turns out that most people don't
have an identifiable lesion on x-ray
and so docs don't have a really
great idea of what to give people
other than drugs or maybe a referral to physical therapy
and those aren't terribly effective.
So what happens is the
patient is often frustrated,
and the doctor feels badly
because they can't really help the patient very well,
and so it's not a pleasant situation.
I think that's one of the values
of complementary therapies is that
patients report at
least subjectively,
that they're quite helpful
and that's the value of doing this research is to really find out
how helpful they are from a more objective perspective.
It's very interesting that we actually have found people
do continue to practice their yoga.
In fact at the very last inter,
interview which is about 3 months
after the classes are over, about two-thirds of the people
in both of our studies reported that they had practiced yoga
in the prior week so that's a very nice confirmation
that for many people it's quite accessible.
It's very interesting that people
want to know what the magic pose is,
but it turns out that a sequence of
poses is actually quite important
in the vini yoga tradition.
And also the poses that can be most helpful
might differ from person to person.
For example if somebody
needs to learn to relax,
the wheel pose and associated very gentle relaxing poses
would be extremely important.
If a person is weak in some area, they'll need to have
some more strengthening kinds of poses, for example.
The ones that strengthen the hip muscles
so it just depends on the individual.
Our posture sequence was designed to provide all of that
so people could get an idea what would be helpful for them.
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Narrator: Five tips for people who are interested in practicing yoga
Yasmine Kloth and John Acton demonstrate various yoga techniques
at Brookside Gardens in Wheaton, Maryland.
Millions of people in the U.S. practice yoga.
Scientists are studying how yoga may be used to help improve health
and to learn more about its safe use. 
Yoga and other mind and body therapies
are being integrated into conventional health care settings.
Interest in these practices often is based on results from research
that has been conducted over the past decade.
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Recent studies in people with chronic low-back pain suggest
that a carefully adapted set of yoga poses
can help reduce pain and improve function.
Other studies also suggest that practicing yoga
(as well as other forms of regular exercise)
might have other health benefits such as
reducing heart rate
and blood pressure,
and may also help relieve
anxiety and depression.
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Studies show that some other health conditions
may not benefit from yoga.
For example, research suggests
that yoga is not helpful for asthma,
and studies looking at yoga and
arthritis have had mixed results.
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Yoga is generally considered to be safe in healthy people
when practiced appropriately.
However, people with
high blood pressure,
glaucoma, or sciatica, and women who are pregnant
should modify or avoid some yoga poses.
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Everyone's body is different, and
yoga postures should be modified
based on individual abilities.
Carefully selecting an instructor who is experienced
and is attentive to your needs is an important step
toward helping you practice yoga safely.
Inform your instructor about
any medical issues you have,
and ask about the
physical demands of yoga.
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If you're thinking
about practicing yoga,
also be sure to talk to
your health care providers.
Give them a full picture of
what you do to manage your health.
This will help ensure
coordinated and safe care.
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To learn more about complementary health practices, visit
nccam.nih.gov
You can also follow us on Facebook, Twitter, and YouTube.
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NCCAM thanks the following people
for their participation in this video:
George Salem, PhD.,
and his team at the University of Southern California in Los Angeles
Karen Sherman, PhD., M.P.H.,
and her team at Group Health Research Institute in Seattle
John Acton, R.N., RYT, Certified Yoga for Seniors Instructor
Yasmine Kloth, M.S., Certified Yoga Instructor
Special thanks to Brookside Gardens and the Department of Parks
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00:18:15,542 --> 00:00:00,000
of the Maryland-National Capital Park & Planning Commission
